Tamara Wrenn, MA, CCE
Just Us Women Productions, LLC
P.O. Box 744
Harriman, NY 10926-0744
917-945-0765 www.JustUsWomen.org

My Philosophy of Childbirth Education
Pregnancy is not an illness but a normal part of a woman’s lifecycle. Unless her pregnancy, labor or birth deviates from a natural & predictable physiological course she should be encouraged, supported and empowered to use her inner strength and instincts to give birth with a conservative use, if any, of medical and technological interventions.
2

 Approach childbirth education as a scientific discipline whose major concerns are helping expectant parents prepare for an optimal birthing experience and learning skills that will enhance wellness throughout life (Nichols, 2000).
3

 The National Healthy Start Association believes that the Healthy
Start program offers the best models for the reduction of infant mortality, low birth weight and racial disparities in perinatal outcomes. This model emphasizes both the importance of community-based approaches to solving these problems, and the need to develop comprehensive, holistic interventions that include health, social and economic services.
 Each Healthy Start project is mandated to develop a local consortium composed of neighborhood residents, medical providers, social service agencies, faith-based representatives and the business community.
This consortium guides and oversees the design and implementation of the local Healthy Start project.
4

 Is your Healthy Start project where you want it to be?
 Is your Healthy Start project where it needs to be?
 Who is on your Healthy Start team?
5

Certified Childbirth Educators (CCE):
 trained healthcare specialists skilled in developing evidence based curriculums that support the needs of mothers.
 in collaboration with Healthy Start have the capacity to identify and address the specific perinatal health needs of a target population for the purpose of improving behavioral, policy and systems changes; and improving client self-efficacy and decision making skills.
 through the use of a conceptual framework the interdisciplinary maternal child health team, inclusive of a
CCE, can expand the use of evidence based practices in childbirth education.
6

16-7.
(Developmental) Increase the proportion of pregnant women who attend a series of prepared childbirth classes.
Potential data sources: National Pregnancy and Health Survey, NIH, NICHD; National Survey of
Family Growth (NSFG) or National Health Interview Survey (NHIS), CDC, NCHS.
As part of comprehensive prenatal care, a formal series of prepared childbirth classes conducted by a certified childbirth educator is recommended for all women by the Expert Panel on the
Content of Prenatal Care.
[49] These classes can help reduce women’s pain [50] and anxiety [51] as they approach childbirth, making delivery a more pleasant experience and preparing women for what they will face as they give birth. A full series of sessions is recommended for women who have never attended. A refresher series of one or two classes is recommended for women who attended during a previous pregnancy. At a minimum, the childbirth classes should include information regarding the physiology of labor and birth, exercises and self-help techniques for labor, the role of support persons, family roles and adjustments, and preferences for care during labor and birth. The classes also should include an opportunity for the mother and her partner to have questions answered about providers, prenatal care, and other relevant issues, as well as to receive information regarding birth settings and cesarean childbirth. Attendance is recommended during the third trimester of pregnancy so that information learned will be used relatively soon after presentation. Classes should begin at the 31st or 32nd week and be completed no later than 38 weeks. The refresher class should be completed at any time between 36 and 38 weeks.
Source: http://www.healthypeople.gov/Document/HTML/Volume2/16MICH.htm#_Toc494699663
7

 Objectives that could not be assessed. At the time of the midcourse review, data to assess progress were unavailable for childbirth classes (16-7).
 As stated in Healthy People 2010, "Most developmental objectives have a potential data source with a reasonable expectation of data points by the year 2004 to facilitate setting
2010 targets in the mid-decade review. Developmental objectives with no baseline [or data source] at the midcourse will be dropped." Although some developmental objectives with no baseline data or data source were deleted as part of the Midcourse
Review, the U.S. Department of Health and Human Services and the agencies that serve as the leads for the Healthy People 2010 initiative will consider ways to ensure these emerging public health issues retain prominence despite their current lack of data.
Source: http://www.healthypeople.gov/data/midcourse/html/focusareas/FA16ProgressHP.htm
8

# Surveyed
Total 1,573 25%
519 first time mothers
56%
1,054 experienced mothers
9%
Participated in
CBE
“70% said the classes helped them to better communicate with their caregivers”
Source: Listening to Mothers Survey II
Report of the Second National US Survey of
Women’s Childbearing Experiences
Childbirth Connection
9

A certified childbirth educator (CCE) is a health specialist trained to be a resource and guide for women on issues of pregnancy, labor and birth.
They are responsible for providing balanced information to clients that is accurate and evidence-based, including identifying social systems and policies based on the risks and benefits they pose to maternal, infant and child health and wellness. CCEs work with clients so that they can become informed decision makers in their own health care practices and choices.
10

 The childbirth education movement was impacted early on by social, political and feminist influences.
 International Childbirth Education Association (ICEA) was founded in 1960. It began as a federation of local consumer groups convened by the Maternity Center
Association (now Childbirth Connections). Its motto was
“Parents and professionals working together to provide parents with the knowledge of alternatives to make informed choices.” The catalyst for national chapters of
CEA.
11

 ASPO/Lamaze Summit on Childbirth and Perinatal
Education in Chicago 1994. Top three conclusions-1) increase the confidence women have in themselves and their ability to give birth without unnecessary interventions: 2) to increase the control women have over their healthcare and education ; and 3) to improve the physical and psychological outcomes or pregnancy
(Nichols, 2000).
 Inclusion of childbirth education in HP 2010 goals organized by Lamaze international. Encouraged childbirth educators to begin a letter writing campaign to project committee members. It was included in the draft and subsequently adopted (Nichols, 2000).
12

 Example of 2007-2008 curriculum offered by Childbirth Education Association of
Metropolitan NY, Teacher Certification Program
HISTORY OF CHILDBIRTH; INDUSTRIALIZATION TO THE PRESENT
ANATOMY & PHYSIOLOGY OF PREGNANCY, LABOR & BIRTH
TEACHING BREASTFEEDING
NUTRITION & FETAL DEVELOPMENT
MEDICATIONS IN PREGNANCY, LABOR & BIRTH
OBSTETRICAL TESTING AND PROCEDURES
CESAREAN BIRTH & PREVENTION
TEACHING LABOR SUPPORT
USE OF ALTERNATIVE THERAPIES IN LABOR AND BIRTH; ACUPUNCTURE,
HERBS, MASSAGE
AND BREATH WORK
TEACHING NEWBORN CARE
PAIN COPING STRATEGIES FOR LABOR & BIRTH
MATERNAL POSTPARTUM ISSUES
PERINATAL LOSS
PUBLIC SPEAKING
TEACHING TECHNIQUES
13

Childbirth Connections (formerly Maternity Center
Association)
 Used its nurse-midwifery service in1948 to provide “natural childbirth” classes emphasizing exercise, breathing and relaxation for the prenatal period and labor and birth (Ettinger, 2006).
 Conducted first natural childbirth demonstration projects in Connecticut and New York. Nurse-Midwives taught a series of six-prenatal classes; one lecture and two exercise classes during the early stages of pregnancy and another lecture and two exercises during the last month on labor and birth (Ettinger, 2006).
14

During a low risk pregnancy
 A traditional certified childbirth educator spends 15-18 hours with a client over a 5-
6 week period in her third trimester alone.
 Prenatal care providers spend about 2-3 hours with a client over the course of her pregnancy during the routine 10 to 15 minute office visit (averages 13 visits).
15

 Total 2002 Medicaid Births 1,661,320
Source: Kaiser Family Foundation, www.statehealthfacts.org/comparemaptable
 Average Health Educator Cost
Annual Median $41,330
Source: US Department of Labor
 Certified Childbirth Educators
Annual Median $49,008
Source: www.swz.salary.com/salarywizrd
 Cost for Certification
Range $505 to $1,450does not include reading materials and incidentals related to certification
16

Enhance the image of insurance companies and managed care plans that provide coverage as a benefit (Nichols,
2000).
Prevention of high risk situations through childbirth education which is part of the wellness model (Nichols,
2000).
Childbirth classes open the door to the discussion of ongoing women’s health issues.
Childbirth classes create a circle of trust where myths can be dispelled and healthy habits supported.
Decreases the risk of a surgical birth ($11,000) versus a vaginal birth ($8,800) (March of Dimes, 2007).
17

1) Hire health educators who are certified childbirth educators.
2) Hire childbirth educators with a background in health education.
3) Train existing health education staff using nationally accepted childbirth education programs/standards (Broussard
& Weber-Breaux, 1994 and Dietrich, 1997)
18

PROBLE
MS
ROOT
CAUSES
IMMEDIATE
CAUSES
19

 Only 1 in 9 (11% out of 1,573 women surveyed ) view childbirth education as part of routine prenatal care
 Lack of integration of childbirth educators as part of interdisciplinary maternal infant health team
 childbirth education has been institutionalized and lost within the medical model of pregnancy (sickness model)
 Healthy People 2010 mid-course review-data to assess progress is unavailable
 Limited community based/grassroots involvement in the delivery of childbirth education
 Research on childbirth education has primarily focused on attitudes of birthing experience with limited focus on its promotion of health behaviors; and influences on self-care.
20

21

No particular order
 Insurance reimbursement policies
 Healthcare economics
 Internalized racism
 Hospital policies
 Capitalism
 Medical institution monopoly on all things birth related
 Medical model of pregnancy elitism
 Lack of knowledge of the historical development of childbirth education, its relationship to the natural childbirth movement, and the related decrease of maternal mortality
22

 Participatory research-ASK the women

Childbirth education curriculums specific to cultural, economic, social and political needs of communities

Conduct studies on childbirth education that include health focused outcomes; health promotion; nutrition; exercise; self-health advocacy (Koehn, 2002)
 Universally health coverage for childbirth education classes as comprehensiveholistic prenatal care
 Decrease in use of the medical model of pregnancy care
 Decrease in medical institution monopoly on normal births
 Expand the use of grassroots/community control of birth

Birth interests of women defined by individual communities
 Identify and implement research activities that support increasing the number of lowincome and women of color who participate in childbirth classes
 Develop a media/social marketing campaign for the target population that identifies, supports, and extols the benefits of low-income women and women of color participating in childbirth education classes.
 Federal financial support for the inclusion of certified childbirth educators on the
Healthy Start teams
23

 Standardize the use of certified childbirth educators on the Healthy Start teams
 Integrate certified childbirth educators into research activities
 Develop policy briefs addressing accountability for developing strategies to assess the HP 2010 progress.
 Research and analyze the literature about childbirth education, its efficacy and cost-effectiveness
 Evaluate childbirth education from a wellness model versus the traditional health education sickness model
24

 trained healthcare specialists skilled in developing evidence based curriculums that support the needs of mothers
 in collaboration with Healthy Start have the capacity to identify and address the specific perinatal health needs of a target population for the purpose of improving behavioral, policy and systems changes; and improving client self-efficacy and decision making skills
 through the use of a conceptional framework the interdisciplinary maternal child health team inclusive of a certified childbirth educator can expand the use of evidence based practices in childbirth education
25

References
Boyd, A. (2006). A Childbirth Educator Speaks Out for Increased Advocacy for Normal
Birth. Journal of Perinatal Education, 15 (1), 8-10.
Broussard. A. & Weber-Breaux, J (1994). Applications of childbirth self-efficacy model in childbirth education classes. Journal of Perinatal Education, 3 (1) 7-14
Dietrich, L. (1997). Assessment and development of childbirth belief-efficacy model in childbirth education classes. Journal of Perinatal Education, 3 (1), 7-14
Ettinger, L. E. (2006). Nurse-Midwifery. The Birth of a New American Profession.
Columbus: The Ohio State University Press
Humenick, S. & Nichols, F. (2000). Childbirth Education: Practice, Research and Theory.
(2 nd edition) Philadelphia, PA: W.B. Saunders Company
Koehn, M. L. (2002). Childbirth Education Outcomes: An Integrative Review of the
Literature. Journal of Perinatal Education, 11(3), 10-19.
26

Childbirth Connection by Harris Interactive in partnership with Lamaze
International (2006). Listening to Mothers Survey II. Report of the Second
National US Survey of Women’s Childbearing Experiences.
Document 11: Anne A. Stevens, “The Work of the Maternity Center
Association, reprinted from the Transactions,” 10th Annual Meeting,
American Child Hygiene Association, November 11-13, 1919. Asheville,
N.C., WCCNY Papers, Archives and Special Collections, Hunter College,
New York, N.Y. (WCCNY microfilm, reel 20, frame 209-31).
Institute of Medicine. Crossing the quality chasm: A new health system for the
21st century. Washington (DC): National Academy Press; 2001.
March of Dimes Study Reveals New Data on the Cost of Having a Baby.
Washington, DC (2007)
27