The Lamaze Certified Childbirth Educator: Standards of Practice

Abstract

A student in a Lamaze Childbirth Educator Program expresses concern that some Lamaze Certified Childbirth Educators (LCCE educators) do not teach classes that reflect Lamaze standards. In this column, the ethical and professional standards of the LCCE educator and the challenges the childbirth educator experiences while practicing in the current maternity-care environment are presented and discussed. Lamaze International's Code of Ethics for Lamaze Certified Childbirth Educators provides guidance when dealing with these challenges.

READER'S QUESTION

I recently completed the Lamaze Childbirth Educator Program. I loved the program, but I am hesitant to take the certification examination. In my community, Lamaze is not well respected, and the “Lamaze” classes at the hospital could not be more different from what I learned in the education program. I am not at all sure I want to be associated with colleagues who are currently Lamaze certified.

COLUMNIST'S REPLY

I can certainly understand why you do not want to be associated with colleagues who do not meet the professional and ethical standards of Lamaze International. However, I believe your decision to sit for the certification examination should be based on the values, principles, and competencies of the Lamaze Certified Childbirth Educator (LCCE educator), not the reputation of a few who might not be meeting those standards. In fact, in every profession, in every walk of life, wide variations occur among individuals' ability and motivation in meeting professional standards. Most of us have, at some time in our lives, encountered a bad teacher or an uncaring health-care professional. Often, the motivation for joining a profession is to do a better job: be a truly excellent teacher, a caring nurse. Passionate, caring, dedicated professionals find their way to Lamaze International and work hard to earn the LCCE educator credential because they want to incorporate the values and principles of (real) Lamaze into their work as childbirth educators.

Passionate, caring, dedicated professionals find their way to Lamaze International and work hard to earn the LCCE educator credential because they want to incorporate the values and principles of (real) Lamaze into their work as childbirth educators.

Like you, I am troubled when LCCE educators teach outdated information that is not evidence-based; when they encourage women to trust technology rather than the natural, physiologic process of birth; and when they encourage the women in their classes to accept routine interventions. I get angry when I hear LCCE educators claim that “formula feeding is just as good as breastfeeding,” that the “epidural is the only way to have a baby,” and that “eating and drinking in labor is dangerous.” My anger and concern, however, renews my commitment to change things, to get the word out about Lamaze International standards of practice, to clarify what we value and believe, and to encourage passionate, caring women, like you, to become Lamaze certified.

The Code of Ethics for Lamaze Certified Childbirth Educators sets out the values, principles, and responsibilities of the Lamaze Certified Childbirth Educator (Lamaze International, 2006). These principles and values set the standard for the practice of childbirth education and are the definitive statement of our professional standards. The newly expanded Code of Ethics outlines the childbirth educator's responsibilities to childbearing women, employers, the profession, and society. The document also provides a roadmap for grappling with issues that inevitably pop up in our day-to-day work as childbirth educators. I'd like to highlight some sections of the Code of Ethics that solidify my confidence in the value of the Lamaze credential.

The newly expanded Code of Ethics for Lamaze Certified Childbirth Educators outlines the childbirth educator's responsibilities to childbearing women, employers, the profession, and society.

CHILDBIRTH EDUCATORS' PROFESSIONAL STANDARDS

The values and principles presented below are the standards for practice of the Lamaze Certified Childbirth Educator (as outlined under the heading of “Ethical Principles” in the Code of Ethics).

Value: Dignity and worth of the person

Ethical Principle: Childbirth educators respect the inherent dignity and worth of the person.

Childbirth educators treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity.

Value: Respect for the normal, natural processes of pregnancy, birth, and breastfeeding, and women's inherent ability to give birth.

Ethical Principle: Childbirth educators embrace the Lamaze philosophies of pregnancy, birth, breastfeeding, and parenting.

Childbirth educators promote, protect, and support normal birth and breastfeeding.

Value: Integrity

Ethical Principle: Childbirth educators behave in a trustworthy manner.

Childbirth educators are continually aware of the profession's mission, values, ethical principles, and ethical standards and practice in a manner consistent with them. Childbirth educators act honestly and responsibly and promote ethical practices on the part of the organizations with which they are affiliated.

Value: Competence

Ethical Principle: Childbirth educators practice within their areas of competence and develop and enhance their professional expertise.

Childbirth educators continually strive to increase their professional knowledge and skills and to apply them in practice. Childbirth educators should aspire to contribute to the knowledge base of the profession.

CHILDBIRTH EDUCATORS' ETHICAL RESPONSIBILITIES

Based on the core values and principles, the Lamaze Certified Childbirth Educator has the following ethical responsibilities to childbearing women (as outlined under the heading of “Ethical Standards” in the Code of Ethics):

Commitment to Childbearing Women: Childbirth educators' primary responsibility is to promote the well-being of the childbearing woman. In general, the woman's interests are primary.

Self-Determination: Childbirth educators respect and promote the right of childbearing women to make informed decisions (informed consent and informed refusal) and assist childbearing women in their efforts to identify and clarify their goals.

Informed Consent: Childbirth educators should provide full, accurate, up-to-date information upon which childbearing women are able to make informed decisions, either informed consent or informed refusal. Childbirth educators should use clear and understandable language to present benefits and risks, as well as reasonable alternatives, and the right to refuse or withdraw consent.

Competence: Childbirth educators should provide services and represent themselves as competent only within the boundaries of their certification.

Cultural Competence and Social Diversity:

• (a) Childbirth educators should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.

• (b) Childbirth educators should have a knowledge base of their clients' cultures and be able to demonstrate competence in the provision of services that are sensitive to clients' cultures and to differences among people and cultural groups.

Conflicts of Interest:

Childbirth educators should be alert to and strive to avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. When a real or potential conflict of interest arises, childbirth educators should first disclose the conflict to clients and then take reasonable steps to resolve the issue in a manner that prioritizes the clients' interests and protects clients' interests to the greatest extent possible.

MEETING THE CHALLENGE OF PROFESSIONAL, ETHICAL STANDARDS

I suspect that the childbirth educators who trouble us the most have issues with one or more of Lamaze International's values and principles. If personal beliefs are an obstacle to embracing these values, one should not be a Lamaze Certified Childbirth Educator. Lamaze International's philosophies of pregnancy, birth, breastfeeding, and parenting are core beliefs and essential components of our standards of practice. It is impossible to disagree and be a Lamaze educator. Promoting, protecting, and supporting normal birth and maintaining competence are essential. Our standards mandate that we teach using “best evidence.”

Each of us is challenged in the current maternity-care environment as we assume our ethical responsibilities as childbirth educators. It is a challenge to present “best evidence” when hospitals provide care that is decidedly not evidence-based. Childbirth educators too often feel pressured to encourage women to comply with hospital policies and routines. Our mandate to assist women in making informed decisions, including making them aware of their right to informed refusal, creates never-ending dilemmas for many childbirth educators. Too many hospital curricula are designed to withhold information and to encourage women to trust their provider and hospital completely. The childbirth educator faces conflicts of interest as she attempts to navigate these dangerous waters, trying to do the best she can to increase women's confidence in their ability to give birth and, at the same time, not lose her job. Childbirth educators struggle with teaching the care practices that promote, protect, and support normal birth, knowing that the choices the women in their classes have already made (caregiver and place of birth) will all but eliminate any real chance of having a normal birth.

It is a challenge to present “best evidence” when hospitals provide care that is decidedly not evidence-based.

In setting out our professional standards of practice, the Code of Ethics for Lamaze Certified Childbirth Educators becomes a valuable support for us in our work. The values, principles, and ethical responsibilities to women, to our employers, and to the profession and society provide a roadmap for us. They clarify who and what we are, for ourselves, and for those who employ us. Our mandate is clear. Our challenge is enormous. We need to be strong in our commitment and understand the importance of being role models and change agents.

I hope you will be inspired to want to hold the LCCE educator credential and make a difference for childbearing women. You will join a worldwide advocacy effort to promote, protect, and support normal birth.