Making a Difference With Evidence

Abstract

In this column, the editor of The Journal of Perinatal Education describes how, despite the many challenges confronting childbirth educators today in our complex health-care environment, there is still a ray of hope that committed individuals translating evidence into practice can make a difference. The editor also describes the contents of this special issue, which celebrates the 50th anniversary of Lamaze International and offers a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.

Wendy C. Budin

Editor

I recently received an e-mail message from my daughter's friend who is expecting her first baby and plans to give birth at the large academic medical center where I work. Her message read:

I was at my prenatal yoga class last night and they always share a birth story of someone that has been in the class. This one woman who had her baby last week was at your hospital [and] described how she was waiting to deliver for [a] few hours but she wasn't dilating enough and the doctor told her she might need to have a cesarean section. So, the nurses were really encouraging and showed her all these positions to move into so the baby would move back towards her pelvis—and it worked! She finally dilated and her labor progressed and she delivered her baby. Everyone in my class was praising the nurses for doing what they could to make sure she didn't have to have an unnecessary cesarean—just thought you'd want to know.

I shared this story of praise for the nurses with the labor and delivery staff and the nursing leadership at the hospital. They were thrilled. It was less than a year ago that the hospital offered a 1-day, Lamaze-sponsored workshop, Evidence-Based Nursing Care: Labor Support Skills, for the entire labor and delivery staff. The goal of the workshop taught by Judy Lothian and Allison Walsh was to provide education, training, and support for labor and delivery nurses to increase labor support skills and the use of nonpharmacologic pain-management strategies. Although the feedback and evaluations at the time of the workshop were extremely positive, it is always nice to see that the nursing staff is translating evidence-based labor support skills into practice and that it is making a difference. This example shows that, despite the many challenges confronted in a large urban academic medical center, given the knowledge and skills, a group of caring individuals who are committed to promoting, supporting, and protecting natural, safe, and healthy birth can make a difference.

IN THIS ISSUE

Continuing the practice of sharing birth stories to advance the Lamaze International mission to promote, support, and protect natural, safe, and healthy birth, this issue's “Celebrate Birth!” column features a story by Charlote De Vries, coauthor of The Official Lamaze Guide: Giving Birth with Confidence. De Vries describes how our daily lives are a series of ordinary moments and unnoticed thresholds—times that define us in ways we often do not give much attention. While we consider childbirth to be one of life's extraordinary events, the hours of labor and birth need not be dramatic (or traumatic) ones. Sharing the birth story of her first granddaughter in the Netherlands, De Vries eloquently describes how a quiet, well-supported birth is cause for celebration of the beauty of an ordinary instant that can define and enrich the human experience.

In this issue's guest editorial, the current president-elect of Lamaze International, Debra Bingham, pays tribute to the 50th anniversary of Lamaze International in her article “Drawing Strength from Our Past to Build the Future.” She sees this occasion as a time to reflect upon our past and present as we work together to build the future of childbirth.

Elaine Zwelling takes us down memory lane as she shares personal memories of her 42-year involvement with Lamaze International. The history of Lamaze International is shared through the recollections of her roles as a childbirth educator, faculty member, and member of the board of directors.

In their feature article, “Steps Toward Innovative Childbirth Education: Selected Strategies From the Blueprint for Action,” authors R. Rima Jolivet and Maureen P. Corry note that as Lamaze International marks its 50th anniversary, it is a fitting time to look back and celebrate the last half-century's landmark accomplishments in education for childbearing women and families, and to take stock of the changing educational needs and preferences of current childbearing families as we look toward the future. Childbirth Connection's multi-year, multi-stakeholder Transforming Maternity Care initiative resulted in two landmark reports: 2020 Vision for a High-Quality, High-Value Maternity Care System and Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System. Selected recommendations of greatest relevance to the field of childbirth education are discussed, and the new Transforming Maternity Care Partnership is introduced.

Kathleen Rice Simpson, Gloria Newman, and Octavio Chirino describe cutting-edge research in their article, “Patients' Perspectives on the Role of Prepared Childbirth Education in Decision Making Regarding Elective Labor Induction.” The purpose of their study was to explore reasons why nulliparous women chose to have an elective labor induction and to identify the influence of prepared childbirth classes on their decision. Study results suggest attendance at prepared childbirth classes can be an effective source of information regarding elective labor induction and influential in women's decisions regarding whether or not to have elective labor induction. Women perceive prepared childbirth classes positively and find the information provided valuable

In a provocative article, “Cruelty in Maternity Wards: Fifty Years Later,” author Henci Goer describes how 50 years have passed since a Ladies' Home Journal article described inhumane treatment of laboring women in U.S. hospitals, yet first-person and eyewitness reports document that medical care providers continue to subject childbearing women to verbal and physical abuse and even to what would constitute sexual assault in any other context. Women frequently are denied their right to make informed decisions about care and may be punished for attempting to assert their right to refusal. Goer advocates that concerted action on the part of all stakeholders will be required to bring about systemic reform.

In a most timely article, “Social Media, Power, and the Future of VBAC,” authors Amy M. Romano, Hilary Gerber, and Desirre Andrews examine the role of online social networks in informing women about VBAC, producing low-cost, accessible decision aids, and enabling multi-stakeholder collaboration toward workable solutions to the barriers women face in accessing vaginal birth after cesarean.

Kristen S. Montgomery and her coauthors share findings from their descriptive qualitative research exploring “Women's Desire for Pregnancy.” Interviews were conducted with 16 women who had given birth in the previous 5 years to identify factors that influenced their desire to become pregnant. The study's findings offer an initial step in understanding the attitudes, motivations, and beliefs of healthy childbearing women and their desire for pregnancy. Increased understanding may help health-care providers develop interventions that not only assist women to conceive as desired but also prevent unplanned pregnancies.

In her column, “Navigating the Maze,” Judith A. Lothian discusses findings of a secondary analysis of data from a larger qualitative study of the experience of home birth. The aim was to describe the ways in which women who plan home birth prepare for their birth. The findings provide support for the idea of birth preparation and education occurring throughout pregnancy and describe the ways in which women planning to give birth at home develop confidence, plan for support, and make decisions related to the particulars of the labor and birth. Implications of these findings for childbirth education are explored.

In this issue's “Tools for Teaching” column, “What Once Was Old Is New Again,” Barbara A. Hotelling suggests that although recently certified Lamaze childbirth educators beginning their teaching careers may have learned of the changes in birth practices over the past 50 years, they may not have heard the personal stories about the locations and conditions in which Lamaze educators first taught. In this column, five childbirth educators share their memories of the birthing climate, teaching strategies, class populations, and other aspects of Lamaze childbirth education 50 years ago and reflect on how the “old ways” compare with today's classes. Their stories provide an important, historical perspective to build on the past and improve future educational opportunities for expectant women and their families and illustrate Lamaze's ongoing efforts to promote natural, safe, and healthy birth practices.

In celebration of Lamaze International's 50th anniversary, reviewers in this issue's “Media Reviews” column—coordinated by Teri Shilling and Stacie Bingham—share their thoughts on some classic Lamaze resource materials and how their content relates to today's viewpoints on birth and childbirth education. Although some of the material may be outdated, all of the resources offer timeless insights as well as a unique view on the history of childbirth education. Two beloved films that were released during the days when Lamaze International was first known as the American Society for Psychoprophylaxis in Obstetrics are reviewed: The Story of Eric and Nan's Class. Marjorie Karmel's seminal book, Thank You, Dr. Lamaze, first published in 1959, is also revisited by two separate reviewers who agree that Karmel paved the way toward natural, safe, and healthy birth practices in the United States. Finally, another reviewer discusses Dr. Irwin Chabon's book, Awake and Aware (1969), and rediscovers important lessons to be learned from the “old” ways of preparing women for birth.