New Possibilities in Childbirth Education

Sandy Jones, MA

Presentation to Northside Hospital

September 29, 2008

The following is a PowerPoint presentation by Sandy Jones, MA, author of Great Expectations: Your All-in-One Resource for Pregnancy & Childbirth. It was presented to childbirth educators, lactation consultants, doulas and nurses involved in pregnancy, labor and delivery at Northside Hospital in Atlanta, Georgia, on September 29, 2008. Northside has the largest birthing center in the nation with over 18,000 births per year. This is an enhanced version with additional slides that go beyond the original 1-hour presentation.

What if we’ve built it and nobody comes?

Childbirth education is facing a crisis.

Class enrollments are diminishing.

Are we turning into dinosaurs?

The old picture

A 2000 study found that 70% of 1st time mothers enrolled in childbirth education classes in year 2000.

A 2002 study* of a nationally representative sample of mothers found that 71% of mothers had attended a childbirth education class prior to giving birth.*

Slusser, WM and Lange, L. Breastfeeding in the United States today: Are families prepared? In Halfon, N, et al. [Eds]. Child rearing in America: The condition of families with young children. Cambridge: Cambridge University Press, 2002:191.

The new picture

56% The number of 1st time mothers who enrolled in childbirth education in 2005

9% The number of experienced mothers who took childbirth education in 2005

Declercq, E. R., Sakala, C., Corry, M. P., & Applebaum S. Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences New York: Childbirth Connection. (2006) p. 24.

Today’s moms most important sources for pregnancy & birth information

• 48% past labor & birth experiences• 33% from books• 19% from friends• 16% the Internet• 14% their doctors• 10% childbirth educators• 4% midwives• 2% mass media (The Listening to Mothers II survey)

(The following slide introduced a facilitated session using sharing from Northside

participants.)

What are the barriers that are keeping moms from taking our

classes?

Identified as barriers by Northside professionals:

• THE INTERNET (Problems: not always accurate; no person-to-person interaction; moms are having trouble weighing the information)

• TIME (Today’s moms are citing the lack of time to take courses that last weeks)

• COST (Families are having a harder time paying for childbirth education classes)

• DISINTEREST (Moms don’t perceive its value)• OTHER DELIVERY OPTIONS (DVD & online

childbirth courses)

The presentation continues…

Time & Work Stress“I’ve got too much on my plate as it is.”

52% Pregnant women who work up to time of delivery.

50% Moms who take leave or quit jobs during pregnancy do so because of medical problems, physical discomfort, stress or fatigue.

Guendelman, S., et al. Utilization of pay-in leave among working women in Southern California. Maternal Child Health Journal. 2006.

Economic pressures“We just can’t afford to take on anything else right now.”

• Atlanta's cost of living is 12.21% higher than the U.S. average.

• Escalating gas, grocery, housing and heating costs are blunting all consumer spending.

• Estimated costs for a U.S. child the first year 2008 are $11,000 - $17,000, excluding pregnancy and medical costs.*

*USDA, Expenditure by families on children, 2007. Miscellaneous Publication 1528-2007 http://www.cnpp.usda.gov/Publications/CRC/crc2007.pdf

Internet & TV birth shows“Why take a class when I can Google it?”

• More than 3/4ths of childbearing women use the Internet for pregnancy information.

• 16% of first-time mothers and 13% of experienced mothers rate the Internet as their most important information source.

• Moms average 20 visits online to get pregnancy and birth information, 1 in 5 (19%) report at least 100 visits.*

• Birthing shows make moms think they understand birth.

The Listening To Mothers II Survey

Epidurals & C-sections“Why take classes, when I already know what’s

going to happen?”63% of moms are having

epidurals.The last decade has

witnessed a 50% rise in births by cesarean sections.

A full 1/3rd of all moms are now undergoing c-sections with 1 out of 2 pregnant women having them in major birthing centers.

Tokophobia:Deep fear of pregnancy and childbirth

“I don’t want to talk about it!”

• An anxious mom postpones or denies the reality of pregnancy and birth.

• She is distressed at the prospect of pain. Seeks an easy way out: “Give me anything you’ve got.”

• She turns her pregnancy over to an “authority” or “father figure” (her obstetrician) to “save” her.

Competition“We want them for ourselves.”

• Doctors aren’t recommending childbirth ed. courses.

• Doctors and midwives are supplying their own wrap-around patient education.

• Other hospitals or commercial vendors are marketing their courses better.

The “me” factorWHAT baby?”

• Some moms view pregnancy and babies as extensions of themselves.•They are captured by the “star” status of pregnancy and use their babies to “compete” with others for beauty, being the best-dressed and smartest.•These moms may be more concerned about tattoos, hair dying and acrylic nails than the prospect of birth.

Here are the moms we know…

The Working Mom

• A multi-tasker who relies on her palm pilot and digital devices.• Efficient and wants things wrapped up quickly• Wants childbirth education in an hour using PowerPoint• Wants her baby to arrive on a specific date so her in-laws will know

when to check in, and she can plan to return to work.

How can we give the working mom what works for her?

• In a time frame that suits her?

• That fits into her busy days and weekends?

• That articulates with her electronic devices so she can access information anywhere: at home, in the car, in an airport?

• That helps to change her mind about c-sections?

The Natural Mom

• Hopes to be a stay-at-home mom• Into the “green movement” • She wants to be healthy and fit• Has experimented with vegetarianism• (Birth)plans to have a natural birth and to

breastfeed• Loves childbirth classes because she and her

partner can meet others and learn all about their bodies

How can we support the natural mom?

• Ensure that she gets her birth wishes?• Help her to succeed at breastfeeding?• Offer her the nutrition and fitness help she

wants?• Give her the social networking and support she

thrives on?

The Single Mom

• Of necessity, she’s having to be strong.• May be single by choice and may (or may not) have a boyfriend in

her life.• May be on Medicaid or not have health insurance.• May live with her parents, or be self-supporting.• Wants emotional and educational support for her pregnancy, but

may feel she doesn’t belong in “couples” classes.• Mounting financial stresses may keep her from participating.

Single-mom facts are surprising!

Percentages tell her story

18% Percent of single, birthing moms in

1984

25% Percent of single, birthing moms in 2003

37% Percent of births to single women now

Families and Work Institute. Generation & Gender in the Workplace. (http://www.familiesandwork.org/site/research/reports/genandgender.pdf)

Single moms vs married moms

2.6 million The number of MARRIED moms giving birth 13,000 The increase in births for married

women between 2005 and 2006

1.6 million The number of SINGLE moms giving birth 117,000 The increase in births for single moms

between 2005 and 2006 to 1.6 million

25 to 29-year old single moms had the largest jump in births.

Families and Work Institute. Generation & Gender in the Workplace. (http://www.familiesandwork.org/site/research/reports/genandgender.pdf)

How can we do a better job of supporting single moms?

• Offer single-mom only classes.• Openly invite grandmothers, friends,

sisters and boyfriends as supporters.• Hold classes at times when Mom can

attend, such as at or after work or on weekends.

• Offer childcare services for her other children.

• Recognize her financial constraints.

How inclusive are we of…

• African-American moms?

• Hispanic, Asian, Indian and other ethnic moms for whom English is a second language?

• Older moms or teenagers who fall out of the “normal range” and have different perspectives, languages and needs?

And are we reaching high-risk moms?

• Obese mom• Mom carrying

multiples• Prematurity and past

miscarriages• Diabetes• High blood pressure• Smoker• Drinker

• Cocaine or meth user• Physical or emotional

abuse, rape victims• Eating disorders• Impoverished• Uninsured• Depressed or

emotionally unstable

Let’s look more closely at a few of these risk categories.

Obesity• Nearly 2/3rds of Americans are considered overweight and 1 in

3 are obese, meaning they have a body-mass index of 30 or greater. Among women 20 to 29 years of age the percent of obese women has almost doubled.

• A non-pregnant woman who is 5 feet, 5 inches tall is obese if she weighs 180 pounds or more. A 5-foot-8-inch woman is obese if she tips the scales at 200 pounds or more

• Over one-third (36.3 percent) of births in one 2004 statewide study were to women who were overweight or obese prior to pregnancy.

• Women who are obese prior to pregnancy are at risk of developing gestational diabetes, pregnancy-related hypertension, preeclampsia, and labor complications; and their infants are at increased risk for neonatal death.

Now, let’s take a look at childbirth education

demographics!

Profile of a Typical Childbirth Education Student

A white, middle- or upper-income parent who is over 25, employed with some college education, is treated by obstetricians and is covered by private insurance.*

*Hamilton, BE, Martin, JA, et al. Births: Preliminary

data for 2005. Health-e Stats (National Center for Health Statistics). November 21, 2006.

A 2003 survey of 1540 childbirth education students found:*

• 64% White

• 46% Some college

• 68% Married

• 15% African American• 17% Hispanic

• 35% High School Graduates

• 32% Single, divorced or widowed

Lu, MC, et al. Childbirth education classes: Sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation. Maternal and Child Health Journal. 2003. (7)2, p. 89.

These moms may feel they don’t belong:

• I’m single.• I’m not white.• I don’t speak English.• I’m fat.• I’m too high risk.• I can’t afford it.• I smoke.• I feel self-conscious in groups.

What can we do to attract more students?

Basics for redesigning childbirth programs:

• Recognize that different moms have different needs

• Redesign our programs to reflect the diversity of our mom population.

• Become more flexible in how we present our information.

(The following slide introduced a facilitated session using sharing from Northside

participants.)

We could…

• Improve our ADVERTISING.

• Target OLDER MOMS.

• Build in INCENTIVES.

• Improve OBSTETRICIAN CONNECTIONS.

• Provide better INDIVIDUAL CONTACT.

• Recognize the MOM CONTINUUM from preconception through motherhood.

How other centers are competing.

Repackaging old content.

• Condensing courses into shorter delivery units.

• Segmenting old courses into distinct mini-classes (“pain options, c-sections,” “breastfeeding,” “waterbirth.”)

• Upgrading descriptions to make them more fun, more casual, and stressing the clear benefits to mom.

Creating new, Consumer-oriented courses.

• Pilates and yoga for moms.

• Pregnancy nutrition and cooking.

• Classes targeting specific mom groups: African-American, Hispanic, working, single, diabetic, smoking, multiples, teens.

• New grandparents.• Siblings’ safaris and

camps. Dads’ “Bootie Camps.”

Changing methods of delivery.

• Internet childbirth ed. courses.

• Lending libraries that mail multi-media materials to parents. (Think: Netflix.)

• Week-by-week e-mails.• Custom books or

magazines.• 24/7 warmlines or

“nurselines.”

Changing locations of delivery.

• Taking courses to the workplace (brown bag lunches.)

• Offering private, in-home services for a fee ($100 per hour.)

• Babyfests that allow parents to connect directly with coaches and providers.

Creating new delivery models.

Lending library

Internet & e-mail

Support groups

Parenting skills

Birth

Pregnancy

BIRTH & BABY CENTER

One example of a redesigned program that wraps around mothers’

needs…

• “Choices in childbirth.” • “Nutrition for the

childbearing year.”• Alternative therapies and

homeopathy.• Lending library.• Mothering Arts support

group.• Midwifery and doula

support.

• Breastfeeding cafe – a drop-in center for breastfeeding moms.

• Mom-oriented products sold in a shop and online.

• Lactation support and courses for working moms.

• Private, in-home coaching.

• www.center4cby.com

(The following slide introduced a facilitated session using sharing from Northside

participants.)

Where do we go from here?

• Re-examine our DEMOGRAPHICS. • SURVEY pre-conceptional and pregnant moms

to discover their words and motivators. • CHANGE from “pregnancy as illness” to

“pregnancy as health.”• BENCHMARK what other hospitals are doing.• REVISE our course offerings and materials.• UPDATE marketing materials and put them in

the language of contemporary moms.

• GET obstetricians and their office managers involved.

• WRAP services around all stages of moms’ conception, pregnancy and parenting.

• CREATE an advisory group to help us re-envision what we offer moms.

• WIDEN the definition of our roles as pregnancy, childbirth and babycare experts, rather than solely childbirth instructors.

Sandy Jones, MA150 W. Southwood Dr.

Brevard, NC 28712Tel: 828-884-4442

e-mail: JonesBabyExpert@aol.com