 The Cascade of Interventions is a typical topic covered in childbirth classes. I don't want to say it's like the Domino Theory of Communism,a logical fallacy known as "slippery slope," but it...it kind of is. As moms, doulas, educators, and birth workers, we often can recall someone's "cascade of interventions" story. The important thing when it comes to teaching is to help students understand that the use of an intervention doesn't mean a woman is fated to the "next" likely step -- with education and awareness, she and her partner can be work to avoid the common pitfalls a specific intervention might bring. Basics:
The story I use:
The bolded statements are being recorded on a large sheet of paper as we read along. After the activity with the boxes, we go through the list and discuss what can be done to avoid or minimize the effects from a specific intervention. This is also the time I hand out basic info sheets about common interventions. I hope I included everything? If you have questions, ask! And please "like" my Facebook page to stay up-to-date on the teaching tips I share. 
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 In celebration of getting my DONA recertification in the mail, I decided to challenge myself to see if I could make this creatively and frugally. This morning I went to Wal-Mart to peruse the Halloween decorations, thinking there had to be a usable pelvis from a skeleton I could use. I found one I thought would work -- and only one, really, out of all the decorations. I live in a small town, and Wal-Mart is just about all we have; I would have checked other places if I lived with more options, because although this one worked, I would have liked to see more samples. That was the only thing I purchased -- everything else I had around the house. Materials List: skeleton with a pelvis embroidery floss orthodontic rubber band needle/thread fabric baggie tape baby that fits the pelvis baby sock for uterus I would use something else for the amnion, but I was grabbing things I had in my house -- nylons might work? Also I would use a newborn's sock, not an 18 months old's sock, for the uterus...you could also knit one. If you have questions, let me know! It took me about an hour from start to finish! And it could save you 70+ dollars! Sorry the order is off -- putting them in order this way on the computer makes the mobile version easier to view.
 I'm an educator that calls pain "pain." I think that is how most people perceive it. I used to feel the "p" word was bad, and I used all manner of euphemisms to avoid saying it. When you teach almost 2000 hours a year, you hear back from a lot of families. When more than one former student came back asking me why I didn't just call it "pain," I decided to adjust my viewpoint. I do have an activity where I "break down the pain" into sensations, involving a bucket and water. The intent is to dissect each sensation, that when clustered together, we call "pain." I find it makes the physical sensations we experience more recognizable and less scary. But I digress! I begin this activity before class, really, when I bring out the Hot Wheels track pieces absconded from my sons. When the first couple arrives, I ask them to put the track pieces together. Once finished, they are laid on the ground, the starting line by me, the finish line at the back of the classroom. You would be surprised how happy it makes people feel to see Hot Wheels tracks and cars on the floor of the classroom where they are learning about how to have baby! This is generally class 3 of our 6, when we discuss pain theories and comfort measures. This is how I share the Gate Theory of Pain, essentially, that we can make pain worse (turn it on) or make it less (tune it down) by what we think, feel, and do.  To start, I lift up the end of the track near me, the starting line, and I let a few cars loose. Unobstructed, they zip down the track like greased lightning (hello, Grease fans!). Then I ask, "What have you heard about, in books or from your friends or family, that helps with labor pain?" People start shouting things out. "Water!" Okay, get your Post-It notes out and write "water" down on one. Choose a partner to come and place his or her shoe under the track, and stick the note on the shoe. Ask again. "Massage!" Same thing. Have a partner come, place his or her shoe under the track at a different point, and slap that Post-It note on the shoe. How many people you have here depends on how long your track is. Pretty soon you have something that looks like this the top image, above (except I have them continue to stand while we do the next part -- I was home alone when I made the pictures here and I opted for empty shoes). Now repeat the exercise with the cars. Start sending them down (I use 5-6 cars). Some will make it all the way to the end, some will slow, and some will get knocked off the track. What you will see, though, is that the undulations made by the shoes (interference, right? Comfort measures) will compete with the "sensation's" ability to get to the end (the brain). We can make sure the road is clear for those sensations to fly straight up and tell us we are in pain, thereby triggering the fear-tension-pain cycle, or we can "congest" those nerve pathways by throwing in other sensations to confuse our brains about what we are really feeling...enter comfort measures and emotional support! Voila.
One other thing about me: I love things that nest. Whether they are baby toys that stack together, measuring cups, boxes, or even Matryoshka dolls -- if it nests, it's the best. I have three different nesting toys that I actually don't let my kids play with...I keep them in the closet with all my childbirth education supplies. One shopping trip, probably 8 years ago (I could look in a catalog to see for certain!), I found these boxes. I was attracted to the nesting, of course. But as I looked closer, I wondered the measurements? Might they be in centimeters, oh maybe, 2ish to 10ish? I went to a handy pencil/map/paper-tape-measure station to check it out. The smallest box was about 2ish centimeters, the next box was 3, 4, 5, and so on, until finally the last box was 10ish. Woo-hoo! I bought about 6 sets!
The bad news is, IKEA doesn't make these boxes anymore. The good news is, maybe you have an affinity for things that nest and there is a set in your possession? Maybe unlikely. But it gets the wheel turning, doesn't it? To be on the look out for what might work? If you are truly motivated, you could make your own, perhaps out of duct tape? I would love to hear your ideas -- let me know what you come up with! And don't forget to "Like" my Facebook page to keep getting ideas!
 I cannot even pretend this was my original idea. I got this from Linda J. Smith's book, Coach's Notebook: Games and Strategies for Lactation Education. In "Who's Glad You're Breastfeeding," Smith offers a list of family and community members who see the benefits of breastfeeding.
I came across a pack of adorable thank-you cards at the Goodwill for $.99, so of course I picked them up with this activity in mind! I took 10 of Smith's suggestions and hand wrote thank-you notes for moms in the group to read out loud. As a modification, I had them withhold who the note was from and the rest of the group had to guess based on the information shared. For example, the one I shared in the picture says: "Dear Breastfeeding Mom, Thank you for breastfeeding. Your child's athletic ability gets a boost from better eye-hand coordination and motor development. From, Future Sport's Coach." Smith has a list of 21 people "glad" a mom is breastfeeding, including her partner, her accountant, er dentist, her OB, her garbage collector, etc. After we read through the 10 I created, I asked what other benefits moms knew about that we hadn't covered. We also, tongue-in-cheek (but maybe not?) composed a letter from a mother-in-law to her breastfeeding daughter-in-law -- maybe as an attempt to imagine what we might appreciate hearing? Nevertheless, it was a fun group activity!  I said before I am frugal. If I had all the money in the world, I am still not sure I would buy supplies if I could get away with making them. In my first class of six, we go over the different changes in the pregnant body. I found these paper ladies at an educational supply store, and immediately I knew how I was going to use them! I am not an artist, but you don't have to be! I broke down the pregnant body into 9 different regions or topics. In my own interpretation, I drew. Then I glued or taped the baby doll form on the mom. On the back of each lady are the common issues associated with each topic. In class, each person or couple gets a lady (depending on class size), and I have an order I like to go in. One by one, participants read from the back of their paper ladies. I check in with the moms, asking if anyone has experienced certain ailments, how she has coped, etc. In my curriculum I have extensive back-up material for each of these changes, in case a family wants more information about something. An alternative to the paper ladies but still using the research information is one that always gets people giggling. Once I forgot my paper ladies at home and I wasn't sure how I could offer the information without just lecturing. I decided to have each couple draw their own pregnant lady, and label the issues themselves. Then they shared with the rest of the class. Hilarious -- I have kept some of those drawings. You wouldn't believe how much grown-ups can have drawing stretch marks or hemorrhoids! The basis of this activity is finding the current information about the physical, emotional, and hormonal changes that happen in pregnancy, and going from there! Get out your markers, tape, and scissors, and start having fun!
 Pictured here are nine babies I use in my childbirth classes. I am cheap -- I mean, frugal. I could have purchased very expensive dolls from a company that specializes in education materials for this purpose. I could have eve gone to Toys R Us and bought them brand new. But being as I love saving money and find it a challenge to see how little of it I can spend and still have a useful item, I decided to scour my local thrift stores. It didn't happen in one day, it took time and persistence, but one by one I acquired these dolls.
See the one on the top shelf, middle position, with the tattoos on his head? He's my favorite, and I bring him out every week to show a baby's position in the womb, or how a baby's head appears when crowning, or how to breastfeed in a laid-back position. The other dolls only come out in the breastfeeding class.I also purchased newborn clothes from thrift stores so they wouldn't be cold and naked. I bet I paid no more than $25 for the whole set. After the class when they are used, I clean their hard surfaces with a Clorox wipe and return them to their cupboard. Once every 6 months I wash their clothes. In "Coach's Notebook," by Linda J. Smith, she cautions about handling dolls as carefully as you would real babies, to model positive behavior for your participants. I have a habit of sitting my little model baby in my lap, facing outward, with his feet crossed at the ankles in a comfy, watching-TV-in-the-recliner position during class. It makes people smile, although a real baby wouldn't sit like that for long. I have a fake uterus I use as well, also purchased at a thrift store -- but I will save that for another post (hint: it was repurposed from something else). There are some things you will just have to buy, like your favorite DVDs or copyrighted printed materials, so anything you can creatively recycle leaves you more in your budget for the things that just won't budge.
first labors are longer. There are ways to help shorten labor length, such as being active and upright. In next week's class we will get into the stages of labor and talk more about that." And so it goes for every worry. If I don't have any information to offer off the top of my head (meaning it was more unusual), I take the break to dig something up. I offer my findings, and I make a promise to find additional sources of information in the coming weeks. My biggest caution is to never leave anyone feeling more worried when they leave than they were before they came. In fact, I ask that at the end of the first class, and I make sure we have about 7 minutes to debrief and digest. How do I address worries that aren't found in a biology textbook? A worry that comes up almost every time is "money." While I don't have any segment of class dedicated to how a family can afford their baby, I do offer many tips on saving money in almost all my classes. Whether it's finding a doula on a budget (class 3), or skipping the expensive breastfeeding gear (class 5) or unnecessary baby supplies (class 6), I like to think (because I am a cheapskate!), if they are along for the ride, they will get some ideas about reducing their expenses a bit. This Operation head is likely hard to come by. I don't know, check eBay. But I have seen two at thrift stores -- I bought one to give to my mentor doula and trainer, and I left the other one on the shelf, not realizing probably somewhere out there, it could be a valuable resource. If I ever see another one, I will buy it! In the meantime, I have seen at least two options that would work for creative minds:
I would cut a hole in the doll above's head, and probably carve out a hole in the wig forms's as well, and add a wig, of course! It's okay to be fun and silly -- it helps put people at ease and keeps them interested. If you have any questions or would like a more detailed outline of this activity, ask. Happy silly, effective, creative teaching! I plan to offer creative tips for educators once or twice a week; "like" me on Facebook to stay in the loop! |
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Stacie Bingham, LCCE, CD(DONA), CBS(LER)Calm, comfortable Lamaze education & experienced support for pregnancy, birth, & breastfeeding serving Bakersfield, Delano, Hanford, Porterville, Tehachapi, Tulare, Visalia + the World
661.446.4532 stacie.bing@gmail.com |
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