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| Posted By |
AUSER on 7/25/2005 5:18:55 PM |
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Employer demands non-evidence based education |
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I've taught childbirth classes for the better part of 14 years. For the past several I have been involved in teaching at teen pregnancy centers. The clientele is sometimes challenging but never boring. Ordinarily the students are adolescents (10-15%) and single, early to mid 20's lower income African American mothers (80%) and immigrants (5-10%). Tough nuts to crack, many immersed in crisis lifestyles.
The birthing climate here is kind of akin to the dark ages. High rate of inductions, c/s, a bunch of women who DO bf come home on nipple shields, only half women are discharged bf. Doulas are few and far between, and hospitals don't like the "rowdy" woman who wants to walk during labor. Black women's outcomes were better off under the rural midwives than with the Medicaid doctors -- yes I can document that. A black woman in my class died in birth last year -- a professional black woman. Over the past 14 years I know 3 women who have died at or around birth, all black, all college educated, all had c-sections.
The lion's share of the students are interested but probably won't make choices to pursue a normal birth. We cover breastfeeding too, and do it fairly well but only a minority choose to breastfeed. I really asses learning needs before handing them a bunch of heavy stuff they aren't ready for. In some classes I have had women who have read everything on the market; and in others NO ONE has read "What to Expect," but a couple have watched cable tv birth shows. Most have heard horror stories about their African American girlfriends giving birth and being treated poorly in the local teaching hospital. I have helped some of these women and they ARE often treated like human cockroaches.
So just like you wouldn't give a first grader algebra, I adapt to the learning needs of the women I serve.
The manual we use is chock full of juicy information, clear and succinct info on the mechanics, with space for them to write -- another adult learning tx -- and what I believe is fair, balanced information on benefits and risks of medical interventions.
My colleague used to always say, "This isn't a class for birth this is a class for LIFE." We talk about the things we can control/can't control (in birth and life), making positive choices, and the ramifications of our choices. We talk about stress management and how exercise, eating well, deep breathing, and the physical and emotional support of others can help relieve stress. We managed to secure doula trainees to help these mothers for free, even though few of them choose normal births -- helping them this way will help them gain life skills-- I believe.
The administration & nurses though didn't see the sense in telling women about options they don't have around here, like doulas or walking during labor
Their paradigm is also, what is written in the book is "taught," a la the way nurses "teach," in other words told or demonstrated to the student/patient. Sometimes it is and sometimes it isn't, but **all choices have consequenses** and I DO tell them about the risks and benefits, not over-emphasising either one, and emphasising communication with their providers.
:::sigh:::: I just needed some input. I am not someone who goes around in a snotty huff making people mad at me. I WILL NOT lead already disempowered women like lambs to the slaughter. I WILL tell them the gentle but honest truth about what choices they have. If you know me you know I do not use underhanded, manipulative or scare tactics and every word I say can be backed up by a nursing text or Cochrane. I'm a doggone good educator, and can coalesce a group of people using games and interaction and caring.
In short how do you handle employers who demand that you cave on evidence-based and interactive teaching?
By: anneboyd |
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