Teaching Techniques

Here are a number of techniques you can use to make your childbirth classes more interactive, engaging, and entertaining. They also all aid understanding, retention, and application. (Note, a few of the techniques are underlined – that indicates that they are hyperlinked to sample activities you can use.)

· Lecture: The most straightforward teaching technique: stand in the front of the classroom, and tell them all the information you think they need to know.

o Advantages: The best way to get the most information out in the least amount of time. May feel most comfortable for a new instructor who wants to control the agenda.

o Disadvantages: students only retain about 20% of what you say to them.* (So, yes, you may say a lot more than you could with some of the other techniques, but most of what you say will be forgotten. It is usually better to pick another technique, and focus on conveying only the most important information in the most memorable manner.) Another disadvantage is that you are controlling the agenda; adult learners will be more interested and engaged if they have an ability to influence what is covered in a class.

· Lecture with Visual Aids: Use posters, models of pelvises and fetal dolls, real medical equipment, etc. to illustrate your points

o Advantages: Seeing objects helps students better understand your points, and also aids in retention. This is especially important for visual learners, and can help kinesthetic learners, especially if you pass items around for them to hold.

o Disadvantages: Choose your visual aids wisely. Old, tattered visual aids imply that the information you are conveying is equally outdated. Some posters are poorly designed, and hard to interpret, and may make things seem more confusing and overwhelming to students. Some items can be scary; for example, if you use a poster illustrating episiotomy, keep it hidden for most of the time, bring it out just long enough to show people, then put it away.

· Lecture while writing on the board. Write a few key points on the board, especially things that are very important for them to remember, such as: warning signs, how often / how long to breastfeed, signs that baby is getting plenty of breastmilk, etc.

o Advantages: Helps to reinforce ideas for everyone, especially beneficial for visual learners to see it written down, and for kinesthetic learners to watch you write it. Also, helps to emphasize what the most important learning points are.

o Disadvantages: This skill comes very easily to some instructors; however, many struggle with trying to write on the board and talk at the same time. If you can’t make it work smoothly, don’t try. (Just write out a flip chart in advance: this will help the visual learners, though it is not as effective for kinesthetics.) You may also want to avoid if you’re a really bad speller – with some students, you can lose credibility if you mis-spell words.

· Question and answers: Whenever you complete a major topic, allow time for questions before moving on to the next topic.

o Advantages: Coming up with questions turns your students from passive learners into active learners, this gets people thinking more. Also, if one student asks a question, others will think to themselves “I want to know that answer too!” They will better integrate information they hear in response to those questions than any information that just gets handed to them in lecture form.

o Disadvantages: If there are too few questions, it can leave you standing and waiting for someone to talk (to prevent this, ask more specific questions! If you just ask: “Do you have questions?” they might not. If you say: “That’s the overview of induction. Before we move on, does anyone have any questions about the reasons for induction, or the benefits or risks of any of the methods we just covered?”, then the more specific query may help them come up with questions. Also, make sure to give a nice long pause after asking for questions so they have a moment to come up with some. The other disadvantage is that if there are too many questions: it’s easy to get distracted on less important topics, and run out of time to cover the essentials. So remember to keep the group disciplined and on-track.

· Brainstorming: Instructor asks a question, all the students give answers. (For example: “what are some comfort techniques which you have heard help with labor pain?” Or “What are some benefits of breastfeeding?”)

o Advantages: Gets students involved. Gives them a chance to share what they know, and reinforce their competency.

o Disadvantage: Don’t overuse this technique: students can quickly feel as if you don’t actually know any information and are hoping they will provide it…

o Things to consider: It’s very important that after they give suggestions, you provide feedback which validates their statement, gives even more information and amplifies what they have said. (e.g. If they said “breastmilk helps babies fight infections”, you say “Yes, absolutely. A breastfed baby is far less likely to have ear infections and respiratory infections.” Also, if you use this to cover a topic where they need to come up with all the answers (like warning signs), make sure you have a list of everything that needs to get covered, and you bring up anything they missed.

· Sorted Brainstorm: When students give responses, the instructor sorts them into categories as she writes them on the board. For example, under reasons for induction, the instructor sorts ideas into three columns, then explains the difference between: clear medical indications where the benefits outweigh the risks, grey areas where the benefit / risk ratio may be unclear (like macrosomia), and areas where the medical risks clearly outweigh the medical benefits (convenience inductions).

o Advantages: reinforces what they already know, but enhances it by sorting it into categories that help them have a fuller grasp of the topic.

o Disadvantages: You are adding some judgment / possible bias to what they have said. Make sure you have the research evidence to back it up, so it’s evidence-based, not just your opinion.

· Demonstrations: Doing demonstrations (e.g. of breastfeeding positions, or of the open-knee-chest position).

o Advantages: helps to clarify what you are saying, and also is helpful to the visual and kinesthetic learners to help them remember what was covered.

o Disadvantages: Make sure you’re dressed appropriately before demonstrating a squat. J

· Demonstration-return demonstration: The most effective way of teaching physical skills. Best as a four step process: 1) you briefly describe what you’re going to show them and briefly describe when they could use this and how it would benefit them. 2) You demonstrate, showing just the most fundamental points. 3) They practice. 4) Feedback: As they practice, you give them feedback, and may add in variations and adaptations that may help them. You also ask them for questions, to help them better understand.

o Advantages: Because they have DONE something, students will understand it, will remember it, and will be able to adapt it to their needs in labor and postpartum. Good for teaching positions, massage, counterpressure, etc.

o Disadvantages: takes more time than lecture or demonstration.

· Labor Rehearsals: Near the end of a childbirth class series, set aside 30 minute of class to have students imagine themselves in labor, and practice a wide range of labor coping skills.

o Advantages: Help to review and reinforce everything that has been taught in the class, and by having the students imagine themselves in labor, you help them figure out how to apply and adapt the skills, and problem-solve.

o Disadvantages: Takes time.

· Role-Plays: You could pretend to be a woman in labor, and ask them to suggest what coping techniques might be helpful to you based on how you are behaving. Or, you can pretend to be a nurse prepping them for an epidural, and encourage them to ask you questions about the procedure. Or, a doctor saying “We may need to start thinking about a cesarean.”

o Advantages: By imagining themselves in the situation, they see the need to learn and practice these skills. Problem-solving and applying knowledge helps with learning and retention. (Hint: Before starting an informed-choice roleplay, give all your students a business card that lists the key questions about benefits, risks, and alternatives, and encourage them to use it as a guide in coming up with questions.

o Disadvantages: You have to be willing to be an actress: the more you ham up the labor symptoms, the more effective it is. If you’re role-playing a medical professional, be RESPECTFUL – it’s easy to play a mean nurse, but don’t do this because that sets up an adversarial relationship between you and care providers. It is OK to play a busy and harried nurse, or to play a nurse who is just so used to the routines of her job that she finds it hard to answer basic questions in layman’s terms.

· Pop Quizzes: A quiz can be done as a small group activity, or homework, or a worksheet handed out in class. Good for reviews of information already covered, especially really concrete info like “where do you go in the building when you arrive at the hospital in labor.” Also good for things that they don’t have to know the answers to, like breastfeeding advantages.

o Advantage: Gets them to really think about whether they know the information or not, and may stimulate some good questions and answers (can also show you where your teaching was effective.)

o Disadvantage: Can be stressful, so it’s important to present it in a way that reduces potential stress. For example, say “I’m doing a pop quiz to review what we covered last week. Now, if you don’t know something, it’s not your fault… it’s my fault, because that tells me I didn’t do a good job of teaching it to you, and gives me another chance to explain it.”

· Diagrams: Some information is most easily presented in diagrams or charts, like length of labor, stages of labor, and so on. For example, when teaching the fear-tension-pain cycle, you can draw a diagram of it on the board, and while drawing it illustrate that as fear goes up, pain goes up, etc. Then you draw a diagram next to it of a confidence – relaxation – physical comforts triangle, and how that cycle can also self-reinforce.

o Advantages and disadvantages: Similar to lecture while writing on the board.

· Small group discussions: Dividing the class up into groups, either randomly, or by gender, or by first-time moms versus experienced moms, etc. Sometimes it makes sense to keep each couple together with their partner, sometimes it’s better to split them up into separate groups so they gain the advantage of hearing two different conversations.

o Advantages: Informal, interactive, gets group members connecting to each other and the class material, fun.

o Disadvantages: You can’t be with all the groups at once, and there may be times when a misconception gets passed around the group that you’re not there to correct. Can be hard to get them to stop talking and rejoin full group.

· Teachbacks: After you have demonstrated breastfeeding positions, have them “teach” you how to do it. After you teach dads to diaper, have them teach the moms. You can also assign homework to students one week, then the next week have them present what they have learned.

o Advantages: One of the best ways to make sure students really understood the information is to have them teach it.

o Disadvantages: Less confident students may be very anxious about doing this. Find ways to make it non-threatening.

· Reflective writing: You hand out papers and pencils, ask the leading questions, and give students a few minutes to write things down. Good for feelings questions (“list some fears you have about labor and birth”) or questions where each person’s answers will be unique (“list some of the activities you enjoy that are really important to you to continue after baby is born, think about how your partner could help you make this happen, and write them a nice note asking them to do so.”)

o Advantages: Gets them to reflect inwardly, and think about their own priorities.

o Disadvantages: Think about how you phrase your questions, and how you describe the process, so it doesn’t feel like “new-agey, psychobabble” to any of your students.

· Games: There are many different styles of games, from dice games, to “Jeopardy” to trivia games, and so on.

o Advantages: Fun, interactive, people solve problems and retain the memory of that problem-solving.

o Disadvantages: tend to take up a lot of time for how much information actually gets covered.

· Videos: Show a video to illustrate your point. Note, you don’t always have to show a full video – sometimes a 3 minute excerpt will perfectly illustrate what you want to show.

o Advantages: Great for all types of learners, as the auditory learners hear the narration, the visual learners see it, and the kinesthetic learners see people moving on screen and can imagine themselves moving. Help to illustrate the “big picture” of labor, birth, and maternity care practices.

o Disadvantages: Don’t overuse – students may feel frustrated if they feel like they paid good money for a class and all you do is show videos. Choose videos well to make sure they reflect current local practice.

o Caution: Graphic videos can be fine for some students, but others will find them troubling (especially families from other cultures). Before showing a video, tell students what to expect in very concrete terms, and give them options for how to handle it. For example: “This will show the placenta being delivered – I want you to know that the placenta is an organ, and it looks like a bloody organ, and some people are uncomfortable with that – you may choose to close your eyes or look away: that part comes after you see the baby on her chest.

· Homework: Worksheets to take home, or lists of skills to practice, or reading assignments.

o Advantages: Gets them thinking about things between classes, and integrating things into their day to day lives.

o Disadvantages: Many students won’t actually do the homework.

Compiled by Janelle Durham, 2009

Check out this article on adult learners and how teaching them is different than kids: www.usdoj.gov/adr/workplace/pdf/learstyl.pdf

Some Trivia from the Web to reinforce the importance of teaching materials in various ways, and the importance of repeating key points in various formats:

· Students remember 10 percent of what they read, 20% of what they hear, 30% of what they see, 50% of what they hear and see together, 70% of what they say, and 90% of what they do.

· If you tell 100 people something once, without repetition: After 24 hours, 25% have forgotten it. After 48 hours, 50% have forgotten it. After 72 hours, 75% have forgotten it. After 1 week, 96% have forgotten it.

· When adult learners hear content only once in thirty days, they only retain 10%, but if they hear the same content six times in thirty days, they retain 90%.

Activities for Childbirth Education Classes

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