What Makes Family Picnic’s Approach to Childbirth Ed Unique?

Different from many childbirth classes, Family Picnic offers a comprehensive program of support for pregnant and new parents that begins with the prenatal period and continues through the toddler years.  After moms and partners sign up for our classes, we are available at any time for their questions or concerns.  Taking our 5-week or intensive weekend Childbirth Class, we begin to get to know parents in intimate, small classes that foster sharing, discussion and support.  When our 3-hour Breastfeeding and Baby Care Workshop is combined with the Childbirth Class, parents receive an at-home lactation consultation following birth.  The consultation not only offers help with breastfeeding but is also a time for questions about baby care, to tell one’s birth story, and to generally see what support the family might need. A Postpartum Workshop follows for all parents about a month after birth. 

Following the Breastfeeding consultation and the Postpartum Workshop, we offer many groups and classes that new parents find helpful: A 5-week Mom and Baby Group; A group called “Motherhood: This Isn’t What I Expected!” for moms wanting to explore more deeply their feelings around birth and becoming parents; A Dad’s Group; Infant Massage; A Baby Play Group; A Sign and Play Class; Yoga for Mom and Baby;  a Toddler Play Group, and a myriad of workshops addressing specific needs of new parents.  In addition, referrals to experienced practitioners are available to our parents ranging from our perinatal therapist to physical therapy. Family Picnic thus becomes a center for support and friendship.  In doing so we welcome all parents:  single parents; straight and LGBTQ couples, immigrants, and moms and partners from many cultures and family traditions. 

Like many traditional childbirth classes, Family Picnic provides a detailed picture of the stages of childbirth and variations that may occur during it. It includes natural pain relief: Positions and movements to help the baby descend; Positions for pushing and birth: and skin to skin immediately following birth. The goal is to familiarize parents with many options so that when they are in labor, they have a repertoire from which to choose. The latest research-based information is included along with up to date recommendations from ACOG.  Many real labor scenarios are presented for moms and partners to discuss, recognizing that there is often not only one way to respond to a situation in labor, and that what might feel right for one couple, might be very different for another. 

Medical pain relief, inductions, and cesareans are discussed in terms of both benefits and risks, as well as situations where there is little choice because of the baby’s or mother’s health.  The effect of these interventions on birth wishes is also looked at, and flexibility encouraged depending on the course of labor. 

Because of the many changes that are occurring in cesarean births, we look at possibilities with Gentle Birth Cesareans. While all may not be available, parents are encouraged to explore them with their surgeon when time permits. The emphasis is on the active participation of the parents in ways that contribute to their positive feelings around their baby’s birth.

In the following ways, we may differ significantly from other childbirth classes with a strong focus on partnership and respect, family and cultural experience, expectations and fears, confidence, flexibility, participation in decision making, and postpartum needs.  For any family who requests it, the class is offered on a sliding fee scale, making it possible for any mom and partner wanting in-depth preparation for childbirth, to receive it.  Parents are never asked their occupation or educational background because the birth of one’s first child is viewed as an equal playing field for all. 

Closely tied with this, is the belief that parents enter a partnership with us and with their health care provider where they play a central role and are respected and listened to.  We know from Anne Lyerly Drapkin, M.D. Ob-Gyn, in A Good Birth:  Finding the Positive and Profound in Your Childbirth Experience that mothers who are at the center of their birth and who have been intimately involved in all decisions, view their birth as a positive one no matter the type of provider (doctor or midwife), birth place (hospital, birth center, home), or kind of birth (vaginal or cesarean). We encourage parents to ask questions and to participate in discussions.  This begins in our first class and continues throughout the course.  It is encouraged at prenatal appointments so that parents have the information before labor begins and are comfortable to continue this dialogue, whenever needed, in childbirth. 

We ask both moms and partners to come to the first class having explored their own birth stories with their parents.  Discussing these, we learn of the beliefs and traditions in many different families in their varied birth experiences.  It provides an opportunity to discuss the rapid changes in birth today, and in particular, changes in the way parents can participate in the birth of their child. For example, a dad was concerned about the importance of prayers for his son immediately after the birth.  Reassured that these were workable expectations, this dad talked with his wife and their health provider about making space for them;  It also opened up opportunities for other dads to explore what their role would be in the immediate postpartum environment.  Another time a mother, whose own mother had had all natural, at-home births, was feeling pressure to meet this ‘ideal’ birth. Through discussion, and especially support from other women, she began to see that her ‘ideal’ birth could be quite different from her mother’s births.  This led other moms to consider conflicting wishes between family traditions and their wishes for their birth.  Gradually in our setting, open to different views and beliefs about childbirth, couples start or continue to navigate how they wish to view both their labor and postpartum environment.

These discussions also open up the importance of flexibility, and mom’s and partner’s wishes to be in control.  In our culture, we are used to making plans that will be carried out according to our wishes.  We tend to build expectations that are usually met, especially in our employment, and can be checked off as successful.  But childbirth is different!  Women do not get to choose the date or time that labor begins, nor the length their labors will take.  In reality, often the most carefully made birth plans are turned on end and unable to be followed.  This raises the question of how a mom and partner can plan for something when neither of them knows the course it will take.  Ultimately, most couples realize that they cannot control labor, and develop wishes rather than plans for its course.  Essential to giving up this control, is building belief in a woman’s body.

We review what a woman’s body has already done.  With no instruction, or computer program, it has nourished a baby through the months of pregnancy:  Growing a placenta and umbilical cord for just this baby; Creating amniotic fluid; Keeping the baby warm, fed, and cradled in fluid; Protecting the baby from things outside the womb; Making it possible for a baby to hear and know the voices of its parents.  It is such a remarkable thing that a woman’s body knows exactly what to do in pregnancy; Why wouldn’t her body also know exactly what to do in labor?  And most often it does, especially when a woman and her partner can trust this process so that the mother gives her body over to this labor, following its changes with movement and sound as it prepares the mother and baby for birth.  Confidence in this process often plays a major part in how a labor will progress.  When that confidence is replaced by fear, and the wish to fight or flee the process, a labor becomes more challenging and difficult. 

For this reason, we also begin a discussion in the first class of the expectations and fears that both moms and partners bring to childbirth. To facilitate this, we divide into two groups:  one for partners and one for mothers, creating safe spaces for them to be shared. Throughout the classes, the leader addresses these fears as they apply to various topics: Research driven information; Participation in decisions; Trust in the expertise of health care providers; Relationships between past experience and fears; And rephrasing fears into positive affirmations. 

For example, a common fear among women is of episiotomies – the cut that used to be routinely made between the vaginal opening and the rectum. Episiotomies are rarely done today.  Physicians and midwives have discovered that tears heal more easily than cuts, and that vaginas in most labors, can expand to accommodate a baby’s head (the biggest part of a baby).  When an episiotomy is needed, the mother is almost always involved in the decision which may provide an alternative to a cesarean.  If there is not time for discussion, the mom and partner’s trust in their physician or midwife is critically important.  Building this trust throughout pregnancy is essential if birth takes an unexpected turn, and quick decisions must be made.  For this reason, we also encourage discussion of this kind of fear to occur with their health provider as well.  

A fear like this is sometimes related to a mom’s past experience, perhaps other times when things occurred to her body over which she had no control.  Recognizing this, a mom might choose to discuss this with a perinatal therapist before labor begins.  And finally, as moms and partners build trust in the mother’s body, they also develop more positive perspectives and create affirmations such as:  “My body was made to deliver my baby;”  “My body will release my baby and help me to bring her into the world;” “I trust my doctor/midwife to help me make the best decisions.”

A common fear among partners is that they will pass out.  This fear is normalized knowing that fainting can happen to anyone, and that there are ways to avoid it, or to deal with it, if it were to happen.  Partners can place themselves beside or behind the mother as he/she supports the mother.  Looking at the mother’s face directs one’s vision away from the actual birth and focuses the partner on the tremendous power and strength of the woman as she delivers their baby.  In this position, partners have the same view as the mother when the baby is lifted up and placed on the mother’s chest – and not on the baby as it emerges. If a partner were to feel faint, she/he can reposition, sit down and get their head lower so that the blood returns to it.  There is no shame in this, only a response that accommodates often overwhelming feelings.  Affirmations develop such as, “I want to help my wife through the labor process and I know to do this I will need to focus totally on her;”  “I am going to let the midwife know that I don’t want to be involved in catching the baby or cutting the cord;”  “I am choosing to be present at the birth to support and encourage my partner as she births our baby.”

Another fear that comes up in every childbirth group is the fear of a sick baby or death at birth of either the mother or baby.  It is understandable that a fear of illness or dying would arise around the beginning of life – after all, both are the critical events which determine our time here.  This fear is normalized as part of being human so that it can be talked about.  Parents are reassured by having selected a provider and hospital they trust, and having enrolled in a childbirth class to be informed participants who will be involved in all decisions effecting the mother’s or baby’s health.   And when asked what they would do if their baby were sick, they invariably tell us that they would make sure their baby had the best care and do whatever was necessary to ensure that.  Considered this way, parents are often reassured by their inner strength that they may have overlooked before.  Affirmations emerge such as, “I have taken good care of my body and my baby throughout pregnancy;” “I know exactly what the hospital will provide if my baby were to need special care;” “I will love and care for my baby and partner no matter what problems might emerge.”  Fears shared and talked about openly give parents many opportunities to deal with them in a variety of ways before labor.

In addition to the group discussions that Family Picnic has, we also encourage dialog between partners.  We use games and discussions for partners both in class and for homework.  Questions for home might include:  How do the mom and partner each feel about the partner seeing the mother exposed and vulnerable in the throws of labor?  What does the mother need to feel protected and safe at this time?  Moms and partners are also asked to work on labor scenarios together, to strategize about them and to see if their responses are similar. A game is played where parents are challenged to each jot down their wishes about a particular issue and then compare them.  For example, questions like the following are used: “When would you leave for the hospital?”  Or “How would you like to deal with pain relief?” This again helps moms and partners work together to resolve or accommodate any differences.  In the final class, moms and partners play a game where they choose all the things they would like for their birth.  Then they are gradually asked, to change the cards to the opposite, and to see how they would feel; then to see how they would feel if they were listened to and respected? In all of these activities, the goal is to help couples recognize their preferences, to build their flexibility, and to work together to resolve issues they disagree on.

We see making decisions during childbirth as the beginning of parenting where throughout the eighteen years of raising children, parents will be making countless decisions.  They will do their best: Some decisions they will be glad about; Others they will regret and want to change.  There is no such thing as a perfect birth, just as there are no perfect parents or children. Rather, it is the desire to do one’s best that often gets parents through challenging times. It is this desire and good will that parents are encouraged to count on. 

Toward the end of our sequence of classes, parents are encouraged to discuss the many changes in their lives that becoming a family of three involves.  While some of these changes are positive, some of them are not.  Some of them involve loss while others are the beginnings of something new and wonderful.  Acknowledging this broad range of feelings, parents can begin to grapple with the dramatic changes in their lives that having a baby will initiate.  They no longer have to pretend, as the world often demands, that everything is wonderful.  Instead, in acknowledging such profound changes and variations in response to them, parents become more prepared and less apt to be taken by surprise. 

This leads to thinking about what a new mother needs after birth in order to recover and care for her baby, including the critical role the partner plays in the postpartum period.  Included, is an in-depth discussion of postpartum depression, and the steps that can be taken to provide the mother with the help that she needs so that she can return to full health as quickly as possible.  If difficulties occur, Family Picnic remains actively involved here, helping mothers and families obtain what they need, and supporting them in doing so. 

Lastly, the childbirth course focuses on the immediate care of the mother and baby after birth and the decisions that parents must make in those first few hours.  This leads naturally to our workshop which follows:  Breastfeeding and Baby Care.

In all these ways parents are prepared for labor and birth, and the immediate period following it.  The mother is more confident in her body and its ability to labor, and more confident in her inner strength to meet the demands of labor; The partner has grown in his ability to support and care for the mother, and in his ability to ask questions and participate with the mother in decisions.  They both know that all one should expect is to do one’s best, and that this will be good enough both in childbirth and parenting.   

 

This Childbirth Class was developed by Sue Gottschall, M.Ed., Ed Psy and Rebecca Nguyen, M.Ed.   It is drawn from our experience as educators, doulas, therapist, and from the Childbirth Educator Trainings of BirthWorks and Informed Beginnings (revised and updated Bradley method).  It represents a compilation of what we believe are the best approaches in several different childbirth class methods (Bradley, BirthWorks, Informed Beginnings, Lamaze, and Birthing from Within), as well as experiences working in education and therapeutic settings.

References

American College of Obstetricians and Gynecologists (ACOG), “Approaches to Limit Intervention During Labor and Birth (December, 2018) P 1-9, https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth?IsMobileSet=false

American College of Obstetricians and Gynecologists (ACOG) “Nations Ob-Gyns Take Aim at Preventing Cesareans” (February, 2014), https://m.acog.org/...ACOG/.../Nations-Ob-Gyns-Take-Aim-at-Preventing-Cesareans

American Journal of Obstetrics and Gynecology, “Safe prevention of the primary cesarean delivery,” (March 2014, Vol 210 Issue 3), p 179-193

 Bardacke, Nancy, CNM, mindful birthing, Harper Collins Publishers, 2014

 Daube, Cathy, Birthing in the Spirit, Birth Works Press, 2007

 Davis, Elizabeth, HEART & HANDS  A Midwife’s Guide to Pregnancy and Birth, Celestial Arts, 2004

 Anne Lyerly Drapkin, M.D. Ob-Gyn, A Good Birth:  Finding the Positive and Profound in Your Childbirth, Penguin, 1913

Gaskin, Ina May, The Guide to Childbirth, Bantam Dell N.Y. 2003

Gaskin, Ina May, Spiritual Midwifery, Book Publishing Co., 2002

 The Gentle Birth Cesarean:  www.npr.org/sections/. . ./the-gentle-cesarean-more-like-a-birth-than-an-operation

Goer, Henci, The Thinking Woman’s Guide to a Better Birth, Penguin, 1999

 Simpkin, Penny P.T. and Phyllis Klaus, When Survivors Give Birth:  Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women,  Classic Day Publishing, 2004

 Simpkin, Penny P.T. and Katie Rohs, The Birth Partner:  A Complete Guide to Childbirth for Dad, Partners, Doulas and All Other Labor companions, 2018

Simpkin, Penny P.T., and Janet Whalley, R.N.. B.S.N., and Ann Keppler, R.N. , M.N., Pregnancy,Childbirth and the Newborn,  New York 2001