Class 1 – Late Pregnancy, Onset of Labor, Early Labor

Intro self. Housekeeping (bathrooms, class structure, breaks, etc.) Have students introduce selves: names, due dates, where delivering. Goals for class. 15 minutes.

Discussion of common discomforts of late pregnancy. Ask them what they’re experiencing. Have them give each other ideas about how to help, also give ideas / information. 10 min

Exercises: Body Mechanics (Lying on Side, Getting up). Optimal Fetal Positioning. Kegels, Squats, and Pelvic Tilts. Tailor Sit and Tailor Stretch. 15 minutes

Nutrition. Where did all these extra pounds go? I’ve got info I give on my webpage at www.transitiontoparenthood.com/ttp/birthed/nutrition.htm 10 minutes.

The Anatomy and Physiology of Labor: 15 minutes

I show non-pregnant and full-term posters, talk about why they have indigestion, shortness of breath, and frequent urination by showing where relevant parts are.

Then, discuss: placenta, amniotic sac, uterus, cervix, vagina, perineum.

Cover oxytocin and prostaglandin and roles in labor.

Cover 6 ways to progress: Cervical position, ripening, effacement, dilation, baby’s station and rotation.

Onset of Labor: some signs that your baby may be on its way. I do a game… I’ve written various symptoms on post-it notes. I hand one to each person / couple, they read it out loud, and then stick it to the board under the title: possible, preliminary, or positive. We discuss how you know labor has started. 15 minutes.

Warning Signs in Late Pregnancy. I write on board or flip chart. 5 minutes.

Overview of the Stages of Labor – A Video I have a great video. 10 minutes.

Relaxed Abdominal Breathing. 5 minutes.

Break

Early Labor: I write summary on board: Frequency and intensity of contractions. 5 minutes

Timing contractions. Write example on board. 5 minutes.

What should I do during early labor? Talk about: Alternate relaxation, distraction, and labor-enhancing activities.

An Early Labor Card Game. I have index cards, with ideas like “take a bath” “go for a walk” “watch a movie”. I give one to each person / couple. They read it out loud, then say why it might be helpful, and whether they think it would be helpful for them. 10 – 15

The Shift from Early Labor to Active Labor. How will I know? Discuss not just timing of contractions, but also change in mom’s mood. (Brief discussion – 2 minutes?)

Why is there pain in labor? What makes it worse? What can help?

Self-care: Eating and resting in early labor. Going to bathroom often. Breathing.

Fear – Tension – Pain Triangle. The reason to learn about labor is to reduce fear, which reduces tension and pain. Relaxation techniques all work with the idea of if we reduce tension, we reduce pain.

Gate Control. Any technique that focuses on distraction (breathing techniques, focal points, aromatherapy, etc) are working with the idea of keeping sensory nerves so busy that the brain doesn’t have much attention left over to notice abdominal pain.

What will my labor look like? How long will it be?

A dice game to explore the range of what’s normal. We make up three imaginary women, and chart progress on board: Have everyone take turns rolling dice

Roll 2 dice to figure out what time labor starts, then flip coin to decide if it’s a.m. or p.m. Have them think about where they might be at this time of day, and how they should respond to labor.

Then, roll 4 dice to figure out how long early labor lasts (anywhere from 4-24 hours). Think about how they would cope with that length of labor.

Then roll 2 dice to figure out how long active labor and transition are. Again, think through what they would need to do to cope with that.

Then roll one die, and divide by 2 to figure out how long their pushing will be.

Again, try to get them to think about their lives and their reality, and really think about how labor will be….

Class 2 – Active Labor and Delivery

Birth Bag Exercise. What comfort items are you bringing to the hospital? 10-15 minutes

Active Labor: Write summary on board. Rule of thumb for when to go to hospital. Going to hospital. (Recommend tours in advance so they know where to park, where to go) 10 mins

Hospital Procedures and Birth Plans

What will the hospital be like? What happens there? 15 minutes

I ask how many of them have been in a hospital before… The “Unwritten Rules” of Hospitals (patients are sick, belong in bed, in hospital gown, etc…. Moms in labor don’t have to follow these rules!) No privacy. Nurses change. Doctor at end of labor.

Triage: Vaginal Exams, Vital Signs. I review.

Fetal Monitoring (show poster, talk about what it’s like, what it shows.)

Food? Liquid? IV? (Discuss various thoughts about eating in active labor)

Birth Plans and Informed Consent. 10 minutes

Comfort Techniques for Labor

What can I do to cope with labor and reduce pain?

Breathing Techniques: Hee-Hee. Hee-Hee-Blow, Slide Breathing 5 minutes

Comfort Techniques: They Brainstorm, I give Feedback. 5-10 minutes

Positions: Hands-On Exploration to figure out which ones work best for you. 5-10 m.

Transition: What does it feel like? What does it look like? Write summary on board. 10 mins

Teach variable breathing, talk about eye contact, staying calm, etc.

Video of Labor and Birth. Pick your favorite. I like Carl and Donna on Hello Baby. 10 mins

Break

Stage 2 Labor: Pushing and Birth

What does it feel like? What does it look like? Write summary on board. 5 minutes.

How will I know when to start pushing? (Urge to push, told by caregiver). 2 min

What are some helpful ideas for Stage 2 Labor?

Breathing Techniques: When pushing. When you are asked Not to push. 5 mins

Spontaneous versus Directed Pushing. 5 minutes

Positions for Birth: Hands-On Practice and Evaluation. 8 minutes.

What happens immediately after the baby is born?

Stage 3 Labor: Delivering the Placenta. Repair of Tears or Episiotomies. 5 minutes

Initial Newborn Procedures. 5 minutes.

Labor Rehearsal: Rotating through the Stations 35 minutes.

Class 3 –Variations, Interventions, Pain Meds

Intros: Practice contractions with ice and breathing. Explain first, then do. Tell them to pick up ice in one hand, and hold it for 60 seconds, fighting it the whole time “this is uncomfortable, it’s cold, it’s dripping, what a stupid exercise, I’m ready for this to be over, etc.” Then time the 60 seconds. Then do a relaxation exercise that takes a minute or two (deep breathing, or some such). Then tell them to pick up another handful of ice (in the other hand!) and go through 60 seconds breathing, imagining themselves in a peaceful place, noticing the ice, but not stressing about it, etc.

Then discuss their impressions: some will say second contraction felt much shorter, reinforce that technique was a good distraction for them… didn’t take discomfort away, but made it manageable. Some will say they liked fighting it better, reinforce for them that it sounds like “active” coping techniques will work better for them than peaceful relaxation, because it will give them something to do and to focus on.

Variations on When and How Labor Begins

What if my labor starts before my due date? Premature Labor. 5 minutes

What if my labor goes really quickly? Precipitous Labor. 5 minutes.

What if my baby is overdue? Brief reminder about the vagueness of due dates, and why it may not be a problem for baby to be late. Brief – 2 minutes?

My doctor has mentioned inducing labor. What does that mean? 10-15 minutes.

Induction: Reasons for, Methods (Natural and Medical – write on board), Risks

Tests of fetal well-being. Favorable Cervix?

First Stage Variations

What if first stage labor is moving really slowly? 5 minutes. Patience versus Augmentation with AROM and Pitocin

Back Labor and Convincing Posterior Babies to Rotate 15 minutes.

Pain Medications. 45 minutes total

If I want to avoid pain medication, what will help me do that? Brief – 2 minutes

What are my options for pain medication? <10 minutes

IV, IM, Epidural. Analgesics (Narcotics) versus Anesthetics

Advantages and Disadvantages of IV / IM medications

What is an epidural? How does it work? 25 minutes

The Epidural Role Play. Practice informed consent. (I take a dad from the audience, fasten ribbons and paper clips and such to him to represent all the different equipment for epidurals…. I just say what it is, then I tell them that if they want to know why I’m putting on these things, what they might show, what side effects might arise, etc. then they need to advocate for this guy, and ask questions!! Gets out all the side effect info, and teaches self-advocacy.)

Maximizing the Advantages and Minimizing the Disadvantages. Write on board, or just discuss.

Massage. 10 minutes

Break

Second Stage Variations and Interventions. 10 minutes

Second stage is going slowly. What can I do? What might doctor do?

Refresher: normal length of labor, position changes

Episiotomy, Forceps and Vacuum Extractor

Cesarean Birth. 20 minutes

Why would I need to have a cesarean section? Are there alternatives? What are the risks?

What is a cesarean?? How does it work? What is recovery like? Video.

What can I do to help avoid a cesarean birth?

Understanding Comfort Techniques. Video. 20 minutes

Labor Scenarios: 30 minutes. A chance to discuss labor variations, and explore ways to cope with them. Divide students up into small groups to discuss scenarios

Class 4 – Postpartum, Breastfeeding & Newborn Care

Introductions: Tell us a little about your experience with taking care of babies, and also your familiarity with breastfeeding (friends and family?) 10 minutes

Breastfeeding, Pumping, and Bottle-feeding. 50 minutes total.

How do breasts make milk? How much milk do they make? 5 minutes

Anatomy and Physiology of the Breast. Hormones. Supply and Demand.

How do I breastfeed my baby? 10 minutes

Positions. Latch. Switching sides. Burping. Show a video showing latch!

When do I feed my baby? How often? How do I know it’s time? 5 minutes

On demand. 8-10 times a day, at least 10 minutes per. Hunger cues. Cues that he’s done.

How do I know my baby is getting enough milk? 5 minutes

Diaper counts. Weight gain.

When should I first breastfeed my baby? When do I wean my baby? <5 min

Breastfeeding in first hour. Exclusive to 6 months, supplement with solid foods till 1 year.

What are the early days of breastfeeding like? What problems might come up? > 5 mins

Colostrum. Mature milk developing. Engorgement, sore nipples. Lactation consultants.

When do I introduce a bottle? How do I bottle-feed? 5 mins

How do I pump? How long can I store milk? 5 mins

Newborn Care. 50 minutes total

What do I need to do before the baby comes? 5 minutes

Get essentials: All baby really needs is diapers, some simple clothes, a carseat, and a place to sleep. All else is optional.

Make decisions: baby’s doctor, circumcising, breast or bottle.

What happens right after the baby is born? 5 minutes

Newborn procedures: APGARS, eye ointment, vitamin K, weighing, bath…

What do newborns look like? What do newborns act like? 5 minutes

Normal Newborn Appearance: Swollen genitals, vernix, jaundice, all that stuff…

Newborn Communication: Cues. States of activity.

Can you teach us how to change diapers? What is swaddling? 15 minutes

Show diaper changes. Have them practice. Talk about meconium, normal breastfed baby poop, normal formula fed. Diaper rash, wiping front to back, cord care, etc.

How much will my baby cry? What can I do to help him stop crying? 5-10 minutes

How much will my baby sleep? What can I do to help him sleep better at night? 5-10 mins

Break

Labor Rehearsal. 30 minutes. I use the labor scenarios cards, Follow the link from

Postpartum Recovery. 20 minutes

How will I feel physically after the baby is born? Lochia, involution, care of perineum, elimination. Taking care of yourself.

How will I feel emotionally after the baby is born? Sleep deprivation, identity changes, feel out of control. What you can do to help yourself. Baby blues / PPD.

What will happen to our relationship after the baby is born? Stress on relationship. Plan now for division of labor. Quality time. Sex after baby.

Resources: Where to Find More Information 5 minutes

Schedule Reunion

Class Evaluations, Time for Questions. 15 minutes.