Discere docendo - Learn through Teaching

Today's antenatal class observation has thrown up a few interesting aspects to teaching that I hadn't really thoght about.

The class itself was mainly about 2nd Stage labour, covering the physiology, what they can expect and positions for dealing with it. The teacher used digarams to show the class what is happening physiologically and then talked to them about the contractions and how they are helping, how the baby moves through the pelvis (good old doll and pelvis demo) and the moulding of the head, crowning, the changes to the perineum etc.

There was advice about perineal massage, coping with crowning, issues around excrement and how to sex the baby (as it can sometimes be difficult!).

Positions was handled by giving the couples 2nd stage position diagrams on cards and asking them to discuss between themselves the relative merits or not that they had. Each couple then demonstrated thier position and commented to the group and the teacher facilitated lively debate about why or when you might use them and alternatives. The teacher made reference to slowing down/speeding up labour, opening the pelvis (she also used the hands through the legs exercise to demonstrate this) use of gravity, arms being up, pelvic tilting to illustrate this.

After the break some postnatal areas were explored. The group were split into male/feamle groups and given a sheet of flipchart paper on which the teacher had drawn a river with ten sharks in it. At one bank 'Birth' was written and the other '6 months' and the groups were asked to write the things which they anticipate being problematic in the sharks fins. Once complete the groups read back what they had written. The papers were then swapped and the teacher asked them to draw stepping stones and in them write things that they thought might help deal with thier partners worries.

The exercise saw some really useful discussion and some common ground between partners and the illustration provided some nice symbolism with teh sharks and stepping stones analogy.

For me personally, there was a tendancy to nod, smile knowingly, grin, grimace, shake my head when certain postnatal issues were discussed and even though I didn't say anything any of the delegates looking would have picked up on my body language. It is so hard when you have recently gone through some of these issues not to show this - so this is something I need to be aware of and conciously not do.

I was also shocked by a discussion around crying babies and how you deal with them. I am no liberal when it comes to childcare and would consider myself to be quite pragmatic in my approach, but most of the group seemed to be very comfortable that the correct way to deal with a crying baby was to first assess it from a distance before picking it up or seeing to it's needs! None of th group countered the discussions put forward which seemingly were unanimous in the view that you don't want the baby to get used to being picked up the minute it cries! I expected that some may have the 'Gina' view but not that everyone would be this way. I know that in reality 'a mothers instinct' will not let these six babies lie in thier cots screaming for long, but nevertheless I was shocked by what went on. The teacher's response to this was to play devil's advocate and challenge them as to why they thought that the baby would have any other motive than to communicate by screaming and gave them some food for thought. This left me reflecting on the fact that part of the teaching role is to prompt the delegates to start thinking about why they feel a certain way and whether or not it is correct - but without imparting my views! Not an easy thing to do. On talking it over with the teacher at the end of the class - she said that challenging was something she did in this intance as there was a lack of any other viewpoint coming forward. She added that it is something that she felt more comfortable to do now that she has more confidence and would not necesaarily have been something she would have done in the early days of teaching. One for me to mull over for certain.

Interesting to note that the couple who are not together seemed strained today (after appearing so together last week). There was reference to the mother being at the birth and they hardly spoke to one another. Both parties were very quiet in group work.

I am half way through observing my second set of antenatal classes. Today's class featured 1st stage labour positions and massage.

It was a really vibrant class - with lots of interactivity and the class are really starting to bond now.

1st atage positions was taught the usual way - cards with diagrams on, and the teacher getting them to take up those positions, the premise being that if you practice the positions you are much more likely to use them in labour. The teacher conducted the discussions in a very holistic manner asking the class when in first stage they might use the positions, bringing how tired or much in pain they may be. She incorporated discussion around what equipment you might have available and how this may differ if you are at home versus in hospital. She discussed with them how some of the positions might be used even if you are being monitored or induced, and the effect pain relief might have on positioning.

I really liked the holistic approach and might explore this more to see what areas I can come up with and how I might do something similar. I made a note in the margins about the possibility of doing the positions in time order, but in discussion with the teacher afterwards she explained that this would remove the ability to get the class to recognise when they might be used and wht might happen to them as labour progresses. She also mentioned that not everyone is comfortable with this exercise early on thus giving an order might make someone feel pressured. Felt the visual aids had seen better days but then she has been using them for 14 years!!! Might be worth putting together my visual aids for this topic now as it's always going to be used.

The massage session also included contraction demonstration. This was illustrated using the white noise tape and the teacher timed the length of time it was on. 1st time through the couples just listened, 2nd time, they massaged in position and sure enough nearly all percieved the latter set as being shorter even though it was longer. The 3rd set illusttrated the longest time of contraction that they could expect (90 seconds). During the end part of the massage session the teacher showed the class some basic strokes and explained a little about using oil and how this can be used. It would be useful to speak to my mum about masage/oils as she is an aromatherapist!!!

All in all a good session - some great ideas! The results of the homework (a mood board about thier perception of thier birth) was really interesting. One of the couples, who I thought had resigned themselves to a highly interventive birth actually announced they were toying with the idea of attending a local birth centre instead of the region's main hospital! Another couple (who are not together, although he does intend to attend the birth) were less positive about thier birth expectations (but possibly mre realistic!). But the nice thing was they seem to be getting closer eeach week that they attend. There was one done solely by the male of the couple - which was interesting! I can't believe that you can set the class homework and they would actually do it! and to a good standard as well. It was a real eye-opener.