OBJECTIVES At the completion of Part 4 the learner will:
■ discuss how curriculum should reflect the goals of a client and her family with each trimester.
■ list three phases of a partner’s adaptation to pregnancy and birth that should influence curriculum.
■ list five considerations helpful in designing a childbirth class.
■ compare and contrast block and spiral sequencing.
■ list concepts to improve recall.
■ define a learner-centered curriculum.
■ write learner-centered objectives using the SMART format.
■ name three domains of learning and write a learner-centered objective in each domain.
■ recognize the importance of evaluating outcome.
Teaching an Early Pregnancy Class
Icebreaker: Hazards of pregnancy (myths and facts), Introductions, Physical Changes of Pregnancy, Discomforts/Comfort Aids:
Body Mechanics, Exercise (Benefits, Suggestions, Pelvic Tilt, Kegel, Precautions):
Emotional changes of pregnancy/sexuality:
Informed Decision making/overview of birth options
Refresher – 1 day (9am -4:30pm)
I remember…? Icebreaker: Write down the first thing that pops into your mind about each topic. Go around room and find other students who wrote the same or similar feelings: Natural childbirth, The Baby, Pain, Hospital, Medication, Doctor or Midwife
Teaching Parents of Multiples – increase in multiple births – ideal when they are taught in classes designed especially for them alone. Preparing for multiples – the family way.
Rationale for special classes – statistically, infants are born earlier and smaller than singletons and less likely to survive 1st year of life. Parents of multiples more likely to need detailed info on preterm labor, bedrest, what to expect in NICU, cesarean. Nutritional needs are considerable different. Prenatal tests more prevalent. Discomforts more exaggerated and appear sooner. Build confidence in parents for a positive, normal birth while at same time realistically preparing them w info they may need to know in case of complications.
Classes should be taken early in 2nd trimester to prepare for different needs and in attempt to prevent potential complications.
Specific needs to be addressed for parents of multiples:
Topic outline for 6-8 hrs of instruction: for those who combine with a general class for parents of single babies or cesarean class.
Morning or Day 1 of 2 day series (pg in multiples handbook):
Break for lunch or 2nd day
Afternoon or Day 2 of 2 day series:
Topic Outline for 12-14 hours of instruction – Parents of Multiples. See VI-10-11
Teaching Tips for Multiples in Singleton Classes – emphasize rate of growth that a woman expecting multiples should expect. Her uterus will be the size of a 40 week singleton mom considerable before she is 40 weeks. She may need to be taught comfort measures sooner.
Be sure to emphasize positive aspects of vaginal birth for moms of multiples. When transition is over, she wont have to repeat the whole labor process. Only pushing is repeated.
In most hospitals, mothers of multiples will be moved to a surgical suite for the birth. Provides necessary space for extra staff and support people for the mother and babies, even if it’s a vaginal birth.
Show video of a twin birth. If don’t want to show to whole class, can show to couple during break or at end of class.
Fun to mention someone famous having a multiple or had multiples. www.tamba.org.uk has interesting and positive articles on twins and triplets in recent news.
www.karengromada.com has pictures of multiples breastfeeding simultaneously.
Emphasize need for postpartum support. Encourage parents to seek additional support from family, friends or professionals for severely weeks after babies come. Postpartum doulas DONA and CAPPA.
Provide resources. Promote local mothers of multiples club and provide contact numbers. Keep referral list of others in past who are willing to speak with expectant moms.
YouTube – Natural Birth of Twins and Triplets: www.youtube.com/watch?v=7E-wULAaD50
DVDs – Prepare parents for multiples; Robyn’s birth from Miracle of Birth 2
Web – Womb Mates
Teaching Teens – consider forming a special program for this important population. For the pregnant teenager, the decision to attend classes may involve more than the common considerations of time, cost or desire. It may also involve a teenager’s need for privacy, acceptance, and respect, which she fear she may not have in an adult centered class.
Similarities and differences between pregnant teens and adults:
Teach pregnant teen local resources in community. Some have support systems, and some have little support. May benefit from a social worker to help her establish prenatal care and follow-up and from support groups to help her deal with emotional aspects of pregnancy. The father of baby has paternity rights if he chooses but law does not require him to be responsible. If he is a responsible partner, he should be encouraged to prepare for birth and parenting with her. The labor partner the woman chooses will not necessarily be the father of the baby.
Who, where, when and how:
Teen Childbirth Class: A School/Community Partnership – Garland (TX) ISD initiated support of New Horizons program to reduce teen dropout rate, which offered:
Basic academic skills, tutoring and educational materials
Funded via federal, state, corporate and private grand funds. Working relationships with department of Human Services, Attorney General’s Office, health clinics, adoption agencies etc.
Teen Childbirth Class– Childbirth is a scary thought to any expectant mother. To a pregnant teenager, it may seem even scarier. Few understand the process and may fear going into labor while at school. Some may even stop attending during last month of pregnancy. Few attend childbirth classes because they feel uncomfortable in the same class with adult expectant parents. Classes are free to any students in the district. Outcomes are sometimes predictable, sometimes unexpected and almost always positive. Unexpected outcomes include changes in some doctors attitudes about pregnant teen’s ability to handle demands of labor, which makes them more willing to accept and respect them as patients. Classes have given teen fathers an opportunity to be involved. They also get a chance to learn and work together. Attendance in last month of pregnancy began to improve. Parents who attend with teen learn how to help pregnant teen, and they feel relief in knowing that help is available.
Common Changes and Concerns in Pregnancy
Your Body’s Preparation for Pregnancy – reproduction anatomy includes internal and external structures. Labia, urethra, clitoris and vaginal opening are external genitals. These plus panus are perineum. Pelvic floor muscles. Internal – uterus (womb, shape of a pear), and vagina -stretchy tube-shaped canal. Lower part of uterus, which protrudes into vagina is cervix. Fallopian tubes provide paths for egg (ovum) to travel from ovaries (sex glands) to uterus. Ovaries produce female sex hormones estrogen and progesterone. During a cycle, egg matures in 1 ovary and causes increased secretion of estrogen, which along with progesterone stimulates growth of uterine lining (endometrium). Usually only 1 egg ripens each cycle and is released into one of your fallopian tubes. Ovulation occurs halfway through cycle. As fine hairs in fallopian tube propel egg slowly toward uterus, ovary produces more progesterone, which stimulates uterine lining to become a rich, nourishing home for a fertilized egg. If fertilization doesn’t occur, estrogen and progesterone levels diminish and your uterus sheds its unneeded lining (menstruation).
Conceiving Your Baby – he ejaculates ~1 tsp of semen, which contains 150-400 million sperm; they can live inside you for up to 3 days, while egg is viable for 12-24 hours after ovulation. Occasionally, woman ovulates more than 1 egg, resulting in fraternal twins, triplets etc or a single fertilized egg divides into 2 and produces identical twins.
Now That You’re Pregnant – breast changes – fullness/tenderness, tingling, darkened aeola; fullness, bloating, ache in lower abdomen; fatigue and drowsiness; feeling lightheaded or faint; nausea, vomiting, frequent urination, increased vaginal secretions
Confirming Pregnancy – hCg – human chorionic gonadotropin, hormone only produced during pregnant. Take 1 test after missed period and another a few days later. Confirm via blood test.
Calculating Due Date – Pregnancy/Gestation lasts average 280 days or 40 weeks after first day of last menstrual period. Difficult to know exactly when ovulation occurred. Simple formula – subtract 3 months from date of last period and add 7 days. Optional ultrasound in early pregnancy to help estimate due date. Babies born healthy and normal any time from 3 weeks before to 2 weeks after; most babies born within 10 days; 5% born on due dates. Due date important to determine best time to do genetic testing, whether results of lab tests within normal range, to diagnose preterm or post-date pregnancy, or see if baby is growing more slowly or rapidly than normal.
Hormonal Changes During Pregnancy – placenta is the major source of hormones
First Trimester Changes for You and Your Baby – “Formation” period because by end of it baby’s organ systems are formed and functioning.
First 4 Weeks
2nd Trimester Changes for You and Baby – “Development” period – baby’s organs and structures begin to enlarge and mature.
3rd trimester changes for you and baby – “Growth period” – changes for an easy transition to life outside womb improve closer to due date.
39th/40th Weeks of Pregnancy
41st Week of Pregnancy and Beyond – Post-Dates
Common Concerns and Considerations in Pregnancy
Note to Expectant Fathers – may never felt so important yet so ignored, so committed yet so abandoned and so deeply in love and sexual yet afraid of sex. Share with other expectant fathers casually or in group.
Special Challenges in Pregnancy – past traumatic experiences can present additional challenges
Key Points: 1st trimester – formation period; 2nd trimester – development period; 3rd trimester is growth period
Nursing Care of the Family During Pregnancy
Pregnancy counted in lunar months, which last 28 days or 4 weeks. Normal pregnancy lasts 10 lunar months, or 40 weeks or 280 days. Trimesters 1: weeks 1-13; 2: 14-26; 3: 27-40. Term at 37 weeks.
Diagnosis of Pregnancy – Presumptive indicators of pregnancy include subjective symptoms (amenorrhea, nausea and vomiting (morning sickness), breast tenderness, urinary frequency and fatigue. Quickening – mother’s first fetal movement between weeks 16 and 20 and objective signs (elevated BBT, breast and abdominal enlargement and changes in uterus and vagina. Others striae gravidarum, deeper pigmentation of areola, melasma (mask of pregnancy), and linea nigra). Probably indicators – physical changes in uterus. Objective signs – uterine enlargement, Braxton Hicks contractions, placental soufflé (sound of blood passing through placenta), ballottement (examiner feels fetus float during vaginal examination), and positive pregnancy test. Positive indicators of pregnancy include presence of fetal heartbeat distinct from mother, fetal movement felt by someone other than mother and ultrasound.
EDB (Estimated date of birth) – Naegele’s rule – accurate recall of last menstrual period. Assumes 28 days cycle and fertilization on 14th day. Subtract 3 months and add a week. Only 5% give birth; most women 7 days before to 7 days after.
Adaptation to Pregnancy – Much or research on family dynamics in U.S has been done with Caucasian middle class nuclear family.
Maternal Adaptation – Early in pregnancy, woman may spend much time sleeping to increased fatigue. Many women are upset initially when they discover they are pregnant, especially if unintended. Non-acceptance of pregnancy does not equate with rejection of child, because a woman can dislike being pregnant but feel love for the child to be born. Sexual desire usually decreases, especially if experiencing breast tenderness, nausea or fatigue. Most important person to pregnant woman is usually father of her child; woman have 2 needs: to feel loved/valued and having child accepted by partner. Phase 1: “I Am Pregnant” – child as viewed as part of self
With perception of fetal movement in 2nd trimester, woman turns attention inward to her pregnancy and relationship with mother and other women who are pregnant. Increased pelvic congestion increases desire for sexual release. Phase 2 “I am going to have a baby” – fetus as distinct from herself, usually accomplished by 5th month. Ultrasound and quickening confirm reality of fetus. Women becomes more introspective. If other children in family, they can become more demanding in efforts to redirect mother’s attention to themselves.
Third trimester – breathing is difficult and fetal movements become vigorous enough to disturb sleep. Backaches, frequency/urgency of urination, constipation and varicose veins can become troublesome. Physical bulkiness diminishes interest for sex. Awkwardness of body interfere with ability to care for other children. Phase 3 “I am going to be a mother” – speculate about child’s sex, especially if unknown and personality traits based on patterns of fetal activity.
Men – some experience pregnancy symptoms – couvade syndrome. Announcement phase – few hours to a few weeks – act with joy or dismay depending on whether pregnancy is planned, wanted. Some men engage in extramarital affairs for first time during pregnancy. Others batter wives for first time or escalate frequency of episodes (Ch 5 = violence against women). Second phase – moratorium phase – more introspective – philosophy of life, religion, childbearing, relationships with family members, particularly father. Third phase – focusing phase – father’s active involvement – begins to think of himself as a father. Identifying with father role – his memories of fathering he received and perceptions of male/father roles within his social group. Daydreaming about role as father is common in last weeks but men rarely describe their thoughts unless they are reassured that such daydreams are natural. Some men become involved by choosing name and anticipating child’s sex. Women’s increased introspection can cause partner to feel uneasy and her reevaluation of couple’s relationship. Last 2 months fathers experience a surge of creative energy at home and on the job. Become dissatisfied with present living space and tend to alter environment. This behavior earns recognition and compliments from friends, relatives and partners. With exception of childbirth prep classes, man has few opportunities to learn ways to be an involved and active partner in this rite of passage into parenthood.
Sibling Adaptation – can be first major crisis for a child. Factors that influence response: age, parent’s attitudes, role of father, length of separation form mother, facility visitation policy and way child has been prepared for the change. 1 year old largely unaware. 2 year old notices change in mothers appearance and may comment “Mommy’s fat”. Toddlers exhibit more clinging behavior and sometimes regress in toilet training or eating. 3-4 year olds- children like to be told story of own beginning and comparison to that of present pregnancy. Listen to heartbeat and feel baby move. School age more clinical interest – how did baby get in, how will baby get out. Early and middle adolescents can have difficulty accepting evidence of sexual activity of parents. Can assume critical parental role and say how can you let yourself get pregnant. Many pregnant women with teenage children will confess that attitudes of teenagers are most difficult aspect of current pregnancy. Late adolescents do not appear to be unduly disturbed –busy making plans of their own.
Tips: Take child on prenatal visit – let child listen to heartbeat and feel baby move. Move child to a bed at least 2 months before baby Is due. Give child a gift from baby. have someone else carry baby from car so you can hug child first. Arrange for special time for child to be a lone with each parent. Do not exclude child during infant feeding times. Can feed doll or drink juice or sit quietly with a game. Can read to child while feeding infant. Praise child for acting age appropriately (so that being a baby doesn’t seem better than being older).
Grandparent Adaptation – Most delighted. Reawakens feelings of their own youth. The historian who transmit family history.
Care Management – more than 75% of women in U.S receive prenatal care in first trimester. Reasons for delaying include cost, lack of insurance, child care, transportation barriers or inability to take time off work. Immigrant woman may come from cultures in which prenatal care is not emphasized. Birth outcomes less positive for these populations, low birth weight and infant mortality associated with lack of prenatal care.
Group prenatal care is alternative to traditional. Facilitates learning, encourages discussion and develops mutual support. CenteringPregnancy well known model of group prenatal care.
Preconception care – before conception – good nutrition, entering pregnancy with as healthy a weigh as possible, adequate intake of folic acid, avoidance of alcohol and tobacco and prevention of STIs and other health hazards.
Prenatal Visit Schedule (Traditional)- first visit in first trimester. Monthly visits weeks 16-28. 2 weeks; Weeks 29-36. Weekly visits 36 to birth.
Discomforts related to pregnancy:
Variations in Prenatal Care/Cultural Influences: variations that influence care include culture, maternal age, medical and OB history and # of fetuses.
Perinatal Care Choices:
Creating a Birth Plan:
Questions to Ask When Seeking a Maternity Care Provider – CIMS (group of>50 nursing and maternity care-oriented orgs produced).
Birth Setting Choices: natural/family/woman centered maternity care can be implemented in any setting. 3 primary options: hospital, free-standing birth center and home. Consider preference, characteristics and reimbursement by insurance. Majority occurs in hospitals, increase in out of hospital births from .87% in 04 to 1.36% in 12. 66% were at home, 29% in free-standing birth centers and remaining 5% in physician’s office, clinic or other.
Exercise Tips for Pregnant Woman- Decrease weight bearing such as jogging and running and increase non-weight bearing such as swimming, cycling, or stretching. if you are a runner, starting in 7th month, can walk instead. Exercise regularly every day. Exercising sporadically can place undue strain on muscles. Take pulse every 10-15 min. if more than 140 BPM, slow down until it returns to 90 BPM. Avoid becoming overheated for extended periods. As body temp rises, heat is transmitted to fetus. Prolonged or repeated elevation of fetal temp can result in birth defects, especially during first 3 months of pregnancy. After 4th month, not exercises flat on your back. Rest for 10 min after exercising, lying on side, which removes pressure and promotes return circulation from extremities and muscles to your heart, thereby increasing blood flow to placenta and fetus. Choose high protein foods such as fish, milk, cheese, eggs and meat.
Discomforts Related to Pregnancy:
Medications and Herbal Preps – possible teratogenicity still unknown, especially for new medications and combinations. Greatest danger of drug-caused developmental defects in fetus extends from time of fertilization through first trimester.
Immunizations – live or attenuated live viruses contraindicated in pregnancy. Live virus include measles (rubeola and rubella), varicella (chickenpox( and mumps as well as Sabin oral poliomyelitis vaccine (no longer used in US). Vaccines that can be administered include Tdap, recombinant Hep B and influenza (inactivated). Tdap should be administered between 27 and 36 weeks during each pregnancy regardless of prior vaccinations. All women pregnant during flue season should be offered. Intranasal contraindicated because contains live virus.
Alcohol, Cigarette Smoke, Caffeine, and Drugs – maternal alcoholism associated with high rates of miscarriage and fetal alcohol spectrum disorders (FASDs); the risk of miscarriage in first trimester is dose related (3+ drinks per day). Cigarette smoking or continued exposure to secondhand smoke associated with IUGR and increase in perinatal and infant morbidity and mortality. Smoking associated with increased frequency of preterm labor, PROM, abruptio placentae, placenta previa and fetal death. Coffee – 200 mg max daily intake
Medications and Herbal Preparations – although much has been learned in recent years about fetal drug toxicity, the possible teratogenicity of many medications, both prescription and OTC, is still unknown. This is esp true for new medications and combinations of drugs. Moreover, certain subclinical errors or deficiencies in intermediate metabolism in the fetus may cause an otherwise harmless drug to be converted into a hazardous one. The greatest danger of drug-caused developmental defects in the fetus extends from the time of fertilization through the 1st trimester, a time when the woman may not realize she is pregnant. Self-treatment must be discouraged. The use of all drugs, including OTC medications, herbs and vitamins, should be limited and a careful record kept of all therapeutic and nontherapeutic agents used.
The use of CAM by pregnant women is widespread. There is limited research evidence about the safety of herbal preparations, esp during pregnancy. Although the use os CAM therapies is consistent w the holistic, woman-centered approach to care, caution is warranted in their use because of the lack of evidence related to their safety and efficacy.
Although CAM may benefit the woman during pregnancy, some practices should be avoided because they can increase risk for complications. Important to ask woman about OTC products (including herbals and vitamins) she is using.
Variations in Prenatal Care – variations that influence care include culture, maternal age, medical and OB history and # of fetuses.
Cultural Influences – standards of care at http://minorityhealth.hhs.gov early prenatal care in not only unfamiliar but also seems strange to women of other cultures. Lack of $, transportation and language barriers, women from diverse cultures may not see care until late in pregnancy or may not participate at al. concern for modesty can be deterrent. For some, exposing body parts, esp to male, considered serious violation of modesty. Invasive procedures such as vaginal exam so threatening they cant discuss it, even w own husbands. Many women prefer females.
Many cultural groups regard care to be necessary only in times of illness. Not considered appropriate during pregnancy.
Cultural prescriptions tell women what to do and cultural proscriptions establish taboos. Purpose of theses practices are to prevent maternal illness resulting from pregnancy-induced imbalanced state and to protect vulnerable fetus. They regulate woman’s emotional response, clothing, activity, rest, sexual activity and dietary practices.
Emotional Response – some cultural proscriptions involve forms of magic. Some Mexicans believe pregnant women should not be allowed to witness an eclipse of the moon because it can cause a cleft palate. Exposure to earthquake can precipitate preterm birth, miscarriage or breech. In some cultures, pregnant women must not ridicule someone with an affliction for fear her child might be born with same handicap. Mother should not hate a person lest her child resemble that person. Dental work shouldn’t be performed because may cause baby to have cleft lip. Folk belief widely held is that woman should refrain from raising arms above head and from tying knots because they tie knots in umbilical cord and can cause it to wrap around baby’s neck. Placing knife under bed of laboring woman will “cut” her pain.
Physical Activity and Rest – norms that regulate physical activity of pregnancy vary tremendously. Some encourage women to be active, to walk and to engage in normal, not strenuous activities to ensure baby is healthy and not too large. Some believe any activity is dangerous and family members willingly take over work of pregnant woman, believing inactivity protects mom and child. Mother encouraged imply to produce succeeding generation. If health care professionals unaware, they may misinterpret as laziness or nonadherence with desired regimen. Important to find out views on activity and rest.
Clothing – modesty an expectation of many. Amulets, medals and beads women by women from some cultures to promote health or protect woman and fetus from danger. Some Mexican women of U.S. SW and Central America wear cord beneath breasts and knotted over umbilicus. Called a muneco, thought to prevent morning sickness and ensure safe birth.
Sexual Activity – most cultures do not prohibit until end of pregnancy. Some view it as necessary to keep birth canal lubricated.
Multifetal Pregnancy – With increased use of assistive reproductive technology and ovulation induction agents, incidence of multifetal pregnancy has risen. In US. Twin birth rate has stabilized at 33.1 / 1000 births. Triplets and higher is 124.4 /10000; a drop from 153.5 in 2009.
Multifetal pregnancy places mother and fetuses at increased risk for adverse outcomes. Maternal blood volume is increased, resulting in an increased strain on maternal cardiovascular system. Anemia often develops because of greater demand for iron by fetuses. Marked uterine distention, increased pressure on adjacent viscera and pelvic vasculature, and diastasis of rectus abdominis muscles can occur. Women at increased risk for gestational diabetes, hypertension and preeclampsia. Placenta previa develops more commonly because of large size or placement of placentas. Premature separation of the placenta can occur before the 2nd and any subsequent fetuses are born.
Multifetal pregnancies often end prematurely. Risk of preterm labor and birth increase w number of fetuses. Spontaneous rupture of membranes common. Fetuses likely to experience growth restriction or discordant growth. There can be local shunting of blood between placentas (twin-to-twin transfusion); this causes recipient twin to be larger and donor twin to be small, pallid, dehydrated, malnourished and hypovolemic. However, larger twin can develop congenital heart failure during first 24 hrs after birth. The risk of death of 1 or more fetuses increases significantly w higher order multiples.
If presence of >3 diagnosed, parents may receive counseling regarding selective reduction to reduce incidence of premature birth and improve opportunities for remaining fetuses to grow to term. Poses ethical dilemma for many couples, esp those who have worked hard to overcome problems w infertility and have strong values regarding right to life. Nurses can help them identify resources (priests, ministers, mental health counselor) to aid in decision making.
Likelihood of multifetal pregnancy increased if 1 or combination of following factors is noted:
Diagnosis of multifetal pregnancy a shock to many parents.
Prenatal care includes changes in pattern of care and modifications in other aspects. Prenatal visits scheduled more frequently. Frequent ultrasounds, nonstress tests, and FHR monitoring will be performed. Mother needs info related to self-management because guidelines differ. Specific instruction regarding nutrition. other about risk of preterm labor and warning signs. Uterine distention associated w multifetal pregnancy can cause backache commonly experienced by pregnant women to be even worse. Maternal support hose may be worn to control leg varicosities. If risk factors such as premature dilation of cervix or bleeding are present, abstinence from orgasm and nipple stimulation during last trimester is recommended to avert preterm labor. Some recommend bed rest at 20 weeks to prevent preterm labor; others question value of prolonged bed rest. If bed rest recommended, mothers assumes lateral position to promote increased placental perfusion. If birth is delayed until after 36th week, risk of morbidity and mortality decreases for neonates.
Multiple newborns can place strain on finances, space, workload and woman and family’s coping capabilities. Lifestyle changes can be necessary. Parents should be referred to national orgs such as Parents of Twin and Triplets (www.nashvilleparent.com/directories/parents-of-twins-and-triplets-organization-potato), Mothers of Twins (www.nomotoc.org) and LLL.
III. Five considerations for class design
Behavioral Objective/Topic/Teachers Strategies/Learners Activities/Min/Teaching Aids Needed/Evaluation Chart for each class
Using a mind map to design your course – a thinking tool that uses free-form, flowing pictures of ideas using colors, words, images and imagination. Aka graphic organizer. Idea is to brainstorm on paper, either alone or in a group. Ideal way to gather your ideas for teaching strategies, evidence-based facts, and comfort skills on a particular topic.
Make a mind map for each of the topics you want to cover:
Using mind maps, make a plan for each of your classes. Divide your topics into chunks of time you have in each class. Can use sticky notes or note cards for easy shifting around. Write what you will spiral into other classes. Figure out how you want to tie it all together. Use colors, various sized circles, curved or dotted lines etc. write as your brain thinks! Gather colored pencils or markers, eraser, colored sticky notes and a marker board or a big piece of paper.
Write class number in center and add or delete rectangles as needed to plan a class.
Topic Outline for 6 Week Series: pgs I28-29 have suggestions for spiraling
Class 1 Review Sheet (to give to students)
Tonight we covered:
Over the next week I hope you both will:
Bring to class next week:
Topic Outline for Weekend Classes pg 20-21
ICEA Statement – Curriculum Development and Content for the Childbirth Educator
Curriculum Development – ICEA endorses a learner-centered curriculum development model. Ongoing, sequential and educational process. Steps as follows:
Content of Childbirth Classes – encompasses entire childbearing year and includes prep for pregnancy, labor, birth, postpartum and early parenting, including breastfeeding, sexuality, changing relationships, and family planning. Should include pre-conception, early pregnancy, mid-pregnancy, later pregnancy and parenting classes.
Class content may include:
ICEA also recommends education in following possible subject areas as appropriate:
ICEA does not promote 1 specific method of childbirth prep – there are many approaches that can help a woman cope w labor. Effectiveness based on:
Class format must provide adequate time for demonstration, return demonstration and practice/review of:
Advocacy of following concepts should be evident:
ICEA Statement – Curriculum Development and Content for the Childbirth Educator see above
Teachers and Learners: Women of childbearing age today fit into 2 categories: “Generation X” (born between 1961-1980) and “Millennials” (born between 1981-2000). Tech-savvy, multi-task, want to have fun while learning, think visually and like experiential learning. Expect good communication.
Prep you do before 1st class will largely determine the success of your series. Should receive text, email or written confirmation of their registration. Need time, date, location of classes, clear directions and map, instructions on what to wear/bring. Might be posted on FB page. Some give info form to be filled out before first class. Sample info forms in Appendix
Contact each couple before class to introduce self and to determine special concerns/needs. Knowing about labor partners may keep you sensitive to language you use. Ask gay, lesbian, bi-sexual, transgender how they would prefer that you refer to them.
Physical needs met before social/higher level needs. Provide snacks for first class. Food enhances social atmosphere and may meet needs of students who missed meal to get there on time. Snacks should be healthy. Can do sign up sheet and ask couples to take turns. Should have access to water.
Make classroom comfortable. Ask them to bring pillows. Ask them if temp, lighting, noise etc is okay.
Most comfortable teaching is often your home, but when looking for a classroom: carpeting/mats for practicing comfort measures on the floor, windows and good lighting with dimmer for relaxation time, pictures on walls – multicultural pics of babies, pics of breastfeeding moms/babies, nature pics, photos that can relate to birth (Harriette Hartigan), variety of seating options – comfortable chairs, beanbags, birth balls, back supports for sitting on floor. Arrange seating in circle or U-shape, so students can see each other.
Reach out to all learners: some come to have fun/hear happy stories about birth; some come eager to ask questions, hear about latest technology and research or seemingly to challenge you. Others want to learn to relax and breathe and be encouraged about giving birth.
Spirals or blocks? Beneficial to teach small doses and repeat frequently rather than to teach all about anatomy, exercises in one, labor support in another etc. spiral curriculum so those who miss a class don’t miss whole subject. Progress from general to specific and each week build on info taught in previous week.
Spiraling by topics
Stages and phases of labor: cover labor onset to birth each week
Relaxation: teach new techniques, building on previous skills, each week
Breathing: teach, review and build on breathing strategies each week
Exercises: just pick a few favs and repeat variations of them each week
Support: teach labor partner to build on skills taught in previous class
Baby: keep focus on baby throughout entire course
Positioning: see pg IV 20 for spiraling suggestions (Study Guide 3)
Breastfeeding see pg IV 136 for … (Study Guide 3)
Postpartum see pg IV 144… (Study Guide 3)
Interactive Teaching Strategies
ICEA Statement: Curriculum Development and Content for the Childbirth Educator see above
ICEA YouTube Channel – Members Minute: Developing Curriculum https://www.youtube.com/watch?v=mledXUnr7eU
All I could find was: Curriculum Design Tutorial (6:36)
Definition of Curriculum – lists of subjects comprising course of study and methodology of teaching those subjects
Parts of a Curriculum: Objectives, Outline, Timing and Teaching Strategies
Objectives must be SMART: Specific, Measureable, Achievable, Realistic and Time-Bound
Use verbs to begin objectives – Bloom’s taxonomy
People generally remember: 10% of what they read, 20% of what they hear, 30% of what they see, 50% of what they see & hear, 70% of what they say & write, 90% of what they do
Types of Teaching Strategies – Childbirth Education Practice Research and Theory: brainstorming, buzz groups, demo/return demo, group centered discussion, panel discussion, case discussion, labor rehearsal, problem solving discussion, experience sharing discussion, guided discussion, exhibits, field trip, games, interview, lecture, TV, debate, nonverbal exercises, peer instruction, question/answer, cartoons/illustrations, diagrams, questionnaire, storytelling, call and response, roleplaying, simulation, values clarifications, imagery/visualization, grab bag, goal setting, worksheets, workbooks, books, journals, handouts, drawing/art, slides, videos, charts, models, photographs, audio recordings, graphs
Calculate timing to teach objective/class
What makes a great curriculum? Focus on learner, in logical order, balanced, up to date/unbiased, and relevant
VII. SMART formatted objectives Specific, Measurable, Achievable, Relevant, Time frame
Posting info on the web can be helpful. However, its rare for a woman and her partner to both sit in front of a computer at the same time for a full childbirth class. Use web to hook students and to entice them to attend one or more in person classes, which provide opportunity for birth partners to meet one another and to hear that most pregnant women are experiencing the same emotions.
Designing Your Course –
Using Chart/Outline- Once you have: considered big picture, set goals for classes, thought about content, and how to teach it so learners will learn and answered question of who, when, where, how often, and how long to teach your classes…then you need a specific course design! Charts and outlines specifically used for this purpose. Chart includes:
Look over topic outlines in this guide. Modify to make them your own or start from scratch with an outline you devise. Think about what it is you want student to know, understand, or be able to do after completing your classes. What teaching activities will it take to accomplish your purpose? How will you construct a learner-centered course? How will you know if students learned what you taught?
If charts/outlines aren’t your style, read further to learn about mind-mapping on page I-13
Ideally speaking, each corporate, department, and section objective should be:
VIII. Domains of learning
http://en.Wikipedia.org/wiki/Bloom’s_Taxonomy (link wrong)
Bloom’s taxonomy is a set of three hierarchical models used to classify educational learning objectives into levels of complexity and specificity. The three lists cover the learning objectives in cognitive, affective and sensory domains.
The cognitive domain involves exhibiting memory of learned materials by recalling facts, terms, basic concepts, and answers. Its characteristics include:
The affective domain (emotive-based)
Skills in the affective domain describe the way people react emotionally and their ability to feel other living things’ pain or joy. Affective objectives typically target the awareness and growth in attitudes, emotion, and feelings.
There are five levels in the affective domain moving through the lowest-order processes to the highest:
The psychomotor domain (action-based)
Skills in the psychomotor domain describe the ability to physically manipulate a tool or instrument like a hand or a hammer. Psychomotor objectives usually focus on change and/or development in behavior and/or skills. Bloom and his colleagues never created subcategories for skills in the psychomotor domain, but since then other educators have created their own psychomotor taxonomies
What are my greatest strengths as a teacher/presenter?
What weaknesses am I trying to overcome?
What would I like to hear said about me after my presentation?
Ask a peer to evaluate you:
What are my greatest strengths as a teacher/presenter?
What weaknesses should I try to overcome?
What is your perception of how I came across to the class?
PCEG Section V: Evaluation (pgs 1-12)
Book – “Evaluating Training Programs: The 4 Levels”; thorough evaluation looks at 4 outcomes:
Classes who get together for a reunion often decide to continue meeting for postpartum support. At the very least, encourage students to include you on their text/email list when they send out birth stories.
Labor and birth questionnaire on pg 117-120 workbook.
Weekly Reaction Form – Tonight I liked; Next week I hope we; 3 things I learned in class are; I wish more time had been spent on; I didn’t like spending so much time on
Course reaction form – 3 things I learned in this course are; what I liked best about this course; I wish more time had been spent on; I didn’t like spending so much time on. On scale of 1-10, how likely would you recommend this course to a friend?
Mid course evaluation form –
Course Evaluation Form:
Summary of Course Evaluation Forms: summarizing the forms you received
Labor and birth survey (for birthing experience)
Maternity services evaluation form – for labor/birth
Childbirth educator peer evaluation form
Society/Media tends to portray birth as potentially dangerous and regard epidural as “the only way to go.” Some feel they should contradict this view by encouraging natural birth. These educators spend little time on medical technology and medications. Others believe they should present comprehensive, evidence-based information regarding the use of medical technology and pain medication in an unbiased way, so that consumers can make their own decisions regarding these issues. Still others present medical interventions in only a positive manner in order to prepare women for the high-tech birth they will most likely have in some locations.
Reality is that most will probably do a little of all 3 above. They want to encourage women that natural childbirth is a possibility, they want women to make truly informed decisions regarding use of interventions and medications and want all women to have positive birth memories, regardless of the use or non-use of interventions and medications.
Think about what it is you want to accomplish in your classes. Answer the following questions, then design your curriculum accordingly: what is the most important goal you have in teaching childbirth education classes? What do you think is the most important goal of students attending your classes? If there is a difference between your goal as a childbirth educator and the goal of your students, how will you address this?
In considering your own philosophy of childbirth, may wish to incorporate elements developed by authoritative organizations, which are active in the field. The following info from Coalition for Improving Maternity Services addresses many of the issues associated with contemporary childbirth. Position papers form DONA, ICEA and Lamaze are included in Appendix.
The CIMS Philosophy of Childbirth – the Coalition for Improving Maternity Services (CIMS) is a national alliance of 27 childbirth organizations and many prominent individuals who came together in 1996 to create the “Mother-Friendly Childbirth Initiative” national childbirth organizations which have ratified this document include Lamaze International, ICEA, the Bradley method, AWHONN, ACNM, DONA, LLL and many more. These prominent organizations believe the philosophical cornerstones of mother-friendly care to be:
Normalcy of the Birthing Process
Autonomy– Every woman should have the opportunity to:
Do No Harm
See CIMS website at www.motherfriendly.org
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 physchoprophylaxis. 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:
Complete chart to help you determine your priorities and preferred teaching strategies
Rate each 1- 4 from not important to very important; indicate strategies you think would be most effective. Make sure you have selected a variety for all learners:
Possible Strategies: lecture (with or without PowerPoint, storytelling, learning task, large group discussion, small group discussion, brainstorming, problem-solving, values-clarification, games/role play, audiovisuals, demonstration/return demonstration, practice, rehearsal, handouts, homework, other)
Important of Topics/Teaching Strategies
Talking the Talk – speaking skills important. Educators frequently asked to speak to peers & other professionals.
For quiet, organized intellectuals, a speaker should be: organized, timely, knowledgeable, trustworthy, thoughtful, intellectual, logical. They prefer discussion with small groups of intellectuals, lecture, research-based studies, slides, handouts, factual videos, homework, research
For relaxed, easygoing mediators, a speaker should be empathetic, nurturing, responsible, happy, intuitive, trustworthy, non-judgmental. They prefer open discussion, games if everyone wins, demo and return demo, videos with positive outcomes
For fun-loving, outgoing talkers, a speaker should be: emotional, creative, intuitive, imaginative, humorous, entertaining, energetic. They prefer discussion of feelings, role-play, return demonstration, hands-on, videos of people and feelings, games
For outgoing, hard-working leaders, a speaker should be authoritative, in control, competent, efficient, futuristic, open minded, and visionary. They prefer discussions, if they can lead, lecture, debates, analysis, meeting goals and objectives.
Showing the Talk – Visuals, props and music
Make sure visual aids enhance and not replace. Models, video clips and toys. Don’t read slides. Keep lights on. VACCINE. Visible – slides high on screen. ACCURATE – verify stats. CLEAR – large, easy to read letters. CONCISE – short and simple. INTERESTING AND INFORMATIVE – color, symbols, pictures, graphs, charts. NEAT – visuals and handouts legible and clean. EFFECTIVE – desired image to emphasize point and increase retention.
Tips for flip charts – write on every other page to prevent marker from bleeding through. Leave a blank page between subjects to serve as topic transition. Use tabs or paper clips on side of pages for ease in flipping to topics. Don’t talk and write at same time unless very good at it. Trace lines or images lightly in pencil, then draw over them with marker. Write notes of points to remember lightly on sides of pages. Always have good markets with you. 1-2 inch letters. Colored stickers (dots in various sizes for bullets). Errors may be corrected by cutting out and pasting a correct version on top.
Using PowerPoint effectively
Need more than bullet points, charts and graphs to be interactive. Images can be used to show a position or exercise, while the instructor or class member demonstrates the proper movement and all students return the demonstration. Slide is visible to all as student experiments. An anatomical drawing appears larger on a screen than on a poster. Wipe in feature allow students to answer questions about an unlabeled drawing, then answers are reinforced when they appear through animation feature. Video clips or music can be embedded on a slide so that you don’t have to involve another piece of equipment. Music can be timed and used for a stretch break or a relaxation sequence. A video can introduce a subject that will be followed by a discussion or learning task. Use slides as a tool to help you keep track, but don’t let them become your entire presentation that your audience could simply read on their own.
For a more engaging presentation, use mostly graphics on your slides. If you use words, use no more than 5-7 words per line in 5-7 lines. Use words or phrases, not sentences. Add graphics to text to make slides more visually appealing. Use bullets, not numbers. Wipe in one bullet at a time to allow for discussion without your audience’s being distracted by reading ahead. Animation may be used sparingly to gain attention and to emphasize a point. Always have a hard copy of your teaching notes with you in case you must give your presentation without electricity or computer!
Polishing Your Presentation
What are my greatest strengths as a teacher/presenter?
What weaknesses am I trying to overcome?
What would I like to hear said about me after my presentation?
Ask a peer to evaluate you:
What are my greatest strengths as a teacher/presenter?
What weaknesses should I try to overcome?
What is your perception of how I came across to the class?