In This Issue—Preparing for Birth During the COVID-19 Pandemic

Abstract

In this column, the editor of The Journal of Perinatal Education discussed how the COVID-19 pandemic has altered many aspects of promoting normal pregnancy and birth practices. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Most expectant mothers look forward to the birth of their baby with anticipation and excitement. One of the rights of passage during pregnancy for many women and their significant other has traditionally been signing up for and attending some form of childbirth education classes. Most often these classes were offered in a group setting where pregnant women and their partners would interact together with a childbirth educator and other expectant couples.

The various restriction imposed by the COVID-19 pandemic has certainly changed our lives dramatically. Over the past year, many aspects of promoting normal pregnancy and birth practices have been altered. Personal interactions between patients and care providers, including in-person office visits have been reduced. This was critical because evidence suggests that pregnant women are more at risk for complications related to respiratory illnesses like the coronavirus. Many hospitals and birth centers placed restrictions on the presence of visitors and support persons including Doulas during labor and afterward. Although the recent availability of vaccines has allowed easing up on some restrictions, sheltering at home and social distancing to stem the spread of the coronavirus, continues to prevent many women from attending in-person childbirth education classes.

Many childbirth educators developed innovative workarounds to meet the needs of expectant couples during the COVID-19 pandemic. As long as internet access was available, childbirth preparation did not have to end. It seemed like overnight there was a proliferation of online and remote childbirth educations classes. With Zoom and other remote platforms, the level of interaction did not need to be completely sacrificed.

A quick online search reveals a wide range of online birthing courses, some of which are free. Virtual childbirth classes can cover everything from relaxation techniques and information about labor and birth to comfort measures and how to develop a birth plan. As with anything, the quality of these offering can vary.

Lamaze International offers an engaging, self-paced online learning environment. On the Lamaze website for parents, there are a variety of resources and tools to prepare for pregnancy, birth, and beyond with virtual access to interact with Lamaze educators and content experts through all stages of pregnancy, preparing for labor or a Vaginal Birth After Cesarean (VBAC), breastfeeding, and parenting. Individuals can learn at their own pace and access the classes anytime from any device. See https://www.lamaze.org/lamaze-classes-online.

The free introductory online class “Labor Confidence with Lamaze” introduces six simple healthy birth practices that research has shown to greatly improve birth outcomes for both mothers and babies, in addition to evidence-based comfort techniques to help minimize discomfort and pain during labor. After completing this online labor class, learners will be able to find resources to help prepare labor and birth; understand six practices to help support a healthy birth; and identify coping techniques to use during early and active labor.

Using a blend of audio, video, reading, and interactive activities, Lamaze International's online class “Labor Pain Management: Techniques for Comfort and Coping” provides information and skills to minimize discomfort and labor confidently. This class covers the stages of labor, providing tips and coping techniques to help each step of the way. Women and their partner can prepare for labor by practicing breathing techniques, labor positions, and guidance on how to prepare their birth team to better support them during labor. Research shows that women supported by doulas request pain medication less frequently and report greater satisfaction with their birth and their partner's participation, so this online class also covers important labor-related topics, such as whether a doula is right for you and how to choose one.

These are just a few examples of how preparing for birth during the COVID-19 pandemic can be accomplished. We would love to hear how others have adapted during this new “normal” birth environment.

IN THIS ISSUE

In this issue of The Journal of Perinatal Education, we continue the practice of advancing the Lamaze International mission to promote, support and protect natural, safe, and healthy birth, by sharing inspiring birth stories. In our “Celebrate Birth!” column, Naima Beckles tell the story of the empowered pregnancy that changed her life. Midwifery led care transformed the experience of Naima Beckles, a Black woman who gave birth for the first time over a decade ago. In this column she describes how an empowered birth laid the groundwork for a career as a birth worker.

In our feature article, “International Water-Birth Practices and Recommendations During a Global Pandemic” Barbara Harper, a world-renowned expert on water birth, examines some of the reasons for the exponential increase in the number of hospitals globally that offer water birth as an option. She also discusses the objections to water birth by ACOG, raised in their 2014 and 2016 opinion statements. She describes how the amount of research has increased as more hospitals are keeping track of their data and publishing both prospective studies and retrospective analyses. The effects of water birth on the neonate are discussed through three meta-analyses from 2015, 2016, and 2018. Finally, Harper highlights and supports with the best available evidence some of the challenges and recommendations on continuing the use of water during labor and birth as a non-pharmacologic comfort measure even during a global pandemic.

Also in this issue, coauthors Chinkam, Steer-Massaro, Herbey, Zhang, Bickmore, and Shorten, describe results of their study that examined the perspectives of women and their health-care providers use of an embodied conversational agent (ECA) to support mode of birth decisions. This study used focus groups to assess the feasibility and acceptability of adapting an ECA to support decision-making about mode of birth after previous cesarean. Participants who included women with previous cesareans along with prenatal providers viewed a prototype ECA and were asked to share feedback on the potential role in helping women prepare for decision-making. Both groups felt that although it was somewhat “robot-like,” the ECA could provide easy access to information for patients and could augment the visit with providers. The investigators recommended future work to improve ECA visual appeal and clarify the role and timing for utilization of decision aids using ECA technology to enhance the shared decision-making process.

Although evidence demonstrates that Doulas have fundamentally improved the health-care experience of pregnant women internationally and women who recognize the importance of not being alone during pregnancy have embraced this role for centuries, less is known about doulas practicing in countries experiencing health inequities like Colombia. In an inspiring article, Daniel Felipe Martin Suárez-Baquero and Jane Dimmitt Champion describe the life history of a Colombian doula. A qualitative methodology was used to answer the question “What life experiences led a Colombian woman to become a doula?” A central theme emerged, “A calling from within: Growing up to accompany the transition from woman to mother.” The path to becoming a doula evolved from life experiences involving health inequities, and a sense of femininity, maternity, and the women's role in rural Colombia.

In another qualitative study, Hinic presents a thematic analysis of coping with the unexpected in childbirth. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Two themes emerged from the women's experiences: “Unexpected birth processes: expectations and reality” and “Coping with birth: the role of healthcare staff.” Participants described unexpected birthing processes, their experiences of care, and maternity care staff's contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.

Finally, in this issue, Furr, Brackney, and Turpin present findings from their quasi-experimental study exploring perinatal nurses' response to shared decision-making education. The participants in this study describe a loss of autonomy during childbirth as a contributing factor to labor dissatisfaction. Shared decision-making with standardized perinatal communication may support a woman's perinatal education and her satisfaction with labor.

Biography

WENDY C. BUDIN is the editor-in-chief of The Journal of Perinatal Education. She is also professor and associate dean for Entry to Baccalaureate Practice at Rutgers School of Nursing. She is a fellow in the American College of Childbirth Educators and member of the Lamaze International Certification Council.

DISCLOSURE

The author has no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.