Tuesday, August 7, 2007

ALACE CBE program

I wanted to share a little bit about what I am doing with ALACE. You can find this (and more) information at http://www.alace.org/

What follows is an article written by Rahima Baldwin, the founder of ALACE.

Our Mission and A History of Childbirth Education
By Rahima Baldwin

ALACE is one of the four major childbirth education organizations which certifies childbirth educators throughout the US and Canada (and we also have teachers in more than 10 foreign countries). The following brief description will help familiarize you with the various approaches in North America today.

The most well-known method of natural childbirth in this country, "Lamaze," was developed around 1950 by Dr. Ferdinand Lamaze in France under the name "childbirth without pain." Lamaze had witnessed women in the Soviet Union giving birth without anesthesia after they had undergone Pavlovian conditioning to breathe and relax during contractions. These women were assisted by a trained "monitrice," whose voice was important in eliciting the conditioned responses. Lamaze further developed his own technique to include implementing the use of varying levels of shallow breathing, and staring at a fixed focal point. Marjorie Karmel journeyed to France to experience such an "awake and aware" birth and brought the movement back to America through her 1957 book Thank You, Dr. Lamaze. Her work was instrumental in founding the American Society for Psychoprophylaxis in Obstetrics (ASPO/Lamaze), the first such organization in America. Just as Kleenex has become nearly synonymous with tissue, Lamaze classes sometimes seem to be used as a generic term for childbirth preparation classes.

During the late 1940s and early 1950s, the influence of Dr. Grantly Dick-Read's pioneering work with natural childbirth in England was gaining a few adherents in America. Dick-Read had attended a woman in labor who refused his offer of chloroform. Afterward she sheepishly had asked, "It wasn't supposed to hurt, was it?" By emphasizing knowledge and relaxation, "childbirth without fear" became a way for women to give birth without being knocked out.

An American obstetrician, Dr. Robert Bradley, was influenced by Dick-Read and came to feel that women who were awake and aware should be sharing this important time with their husbands. Through his influence, husbands started "coaching" their wives and being admitted to the delivery rooms when their wives had attended prepared childbirth classes. "The Bradley Method" and "Husband-Coached Childbirth" are registered trademarks of Bradley's approach, which is known for teaching slow, deep breathing for labor contractions and for their students consistently showing an excellent record of avoiding drugs and anesthesia in labor.

As the natural childbirth movement gained ground during the '60s, another national organization, ICEA (International Childbirth Education Association) was founded with a more eclectic approach to childbirth education than ASPO, drawing from the work of Dick-Read, Lamaze, Kitzinger and others. Unlike ASPO, which trains mostly nurses and physical therapists, ICEA does not have a credential or college requirement, recognizing that women who are mothers already have the proper "credentials" to train to be excellent childbirth educators.

The Association of Labor Assistants and Childbirth Educators (ALACE) is a nonprofit educational organization formed in 1995 to promote and support the professions of childbirth education and birth assisting. It trains and certifies both childbirth educators and birth assistants (doulas, monitrices) through the programs developed and previously offered by Informed Homebirth/Informed Birth & Parenting.

Informed Homebirth (IH) was founded by Rahima Baldwin Dancy in 1977 in response to the need for information on how to prepare for a safe delivery at home; the original childbirth educator training program was developed in 1978. While most of the early IH teachers came from a homebirth background, they soon found themselves teaching hospital-bound couples as well. In 1981 the second name "Informed Birth & Parenting" was added so that pregnant women and couples could more readily identify instructors as having the information they wanted to know, regardless of where they were giving birth. More than 2,500 women have enrolled in this training program since 1977.

The internationally-recognized series of weekly preparation classes were among the first to emphasize visualization and the psychological aspects of pregnancy, birth and parenting, and consistently take a woman-centered, consumer-oriented stand toward obtaining maternity care. Developed by a woman who is herself a mother and midwife, the classes don't teach any "method," but emphasize tools for working with the intensity of labor, and stress the knowledge and confidence necessary to help achieve relaxation and to help with the decisions which labor and delivery often involve. Recognizing that relaxation is the key to natural childbirth, only the slow, deep breathing of relaxation is emphasized. Communication skills are also practiced, because only the laboring woman can know what she is feeling or what she needs.

The present program was developed in 1993, having been completely revised by Rahima Baldwin Dancy and Catherine Stone, with input from other IH/IBP teachers as well. In 1995 ALACE was formed to promote the two programs formerly offered by IH/IBP, leaving Informed Homebirth free to concentrate on midwifery and birth at home and the annual Magical Years Conference on the young child.

The ALACE Childbirth Educator training program combines the important psychological perspectives on birth that have always distinguished Informed Birth & Parenting classes with insights into the far-reaching sociological and anthropological influences that shape women's experiences of birth in our culture. The goal of the classes is to empower women in this important area of their lives, so they have the tools and the confidence to actively give birth and make the choices that will lead to the best possible birth for themselves and their babies.

The prime emphasis of the program is for pregnant women to make active choices to create the best possible birth experience--whether it be in the hospital, at home or in a birth center.

Copyright © 1995-2004 ALACE
http://www.alace.org/ info@alace.org

Birthing Eden

I am Amy Blake Rollogas and I am a childbirth educator. My training is with ALACE. ALACE is the Association of Labor Assistants and Childbirth Educators. They are a wonderful organization, and I chose to train with them because of their woman-centered approach to birth.

I wanted to give you a little bit of background on my own reasons for pursuing this certification. For those of you who know me well, or who are loyal readers of Life In Fife (all 2 of you!) some of this may be redundant. Feel free to skip the birth story if this is your 17th time reading it!

I am a nursing school dropout. I went to nursing school after a lifetime (read: childhood) of saying that is what I wanted to do. I didn't like it from the start. It was not a good fit for me. While I sometimes think I should have stuck it out long enough to finish, I have never wished I was a nurse!

While I was in nursing school, I had a wonderful OB clinical instructor. She was a Certified Nurse Midwife named Jessica Jordan. She opened my "medical" mind to how beautiful birth could (and should) be. It would be several years before I would birth my own daughter, but my thinking about pregnancy and birth had already been changed.

I began seeing Nadene Brunk, CNM for all my well woman care. When Brandon and I conceived in February of 2006, I continued seeing her for my prenatal care. We had a wonderful pregnancy. It was enhanced by the relationship we developed with Nadene. She supported me in my decision to pursue an unmedicated, low-intervention pregnancy and birth.

Brandon and I took natural childbirth classes with a local educator named Chris Prescott (who is no longer teaching). This class was wonderful. Chris did a fabulous job of helping us prepare physically and mentally for birth. I became convinced that good quality childbirth education is key to a positive birth experience. Brandon got even more out of our class than I did! As a voracious reader, there wasn't much factual information about birth I hadn't already read about. Brandon, on the other hand, got most of his info from this class. A well-prepared husband was a great asset during labor!

Toward the end of my pregnancy my blood pressure was a bit high. I was having it checked twice a week with a great desire to avoid being induced. Nadene was a great support as I approached 41 weeks pregnant. Every day past my November 1st "due date" was mentally grueling. I knew that the due date was just an estimate, but it had been the psychological "end" of my pregnancy.

Monday, November 6, 2006
After 3 weeks of sitting around the house waiting for baby, having tons of contractions every day and trying to keep my blood pressure down, I had gone 4 days past my due date. Brandon and I stayed home from church on Sunday because I thought that if I heard even one remark like, “You haven’t had that baby yet?” I might have an emotional breakdown.

Monday morning, one of the pastors from our church, Jim, called to check on me. He had been checking on us every few days, and had noticed that we weren’t in church. After talking with him for a few minutes, I had him assured that I was feeling great (I was!) and that we figured we would be waiting still a bit longer for our new little arrival. I hung up the phone and stood to let the dogs in the back door. Fortunately I was wearing sweatpants (very absorbent) because when I stood, my water broke! The elastic in the ankles of the sweatpants saved our brand new carpet from disaster! It was 9:30am.

Filled with butterflies of anticipation, I called Brandon to tell him to come home from work. He didn’t answer, so I left him a message. I still wasn’t having any “real” contractions, so I relayed that to his answering machine and got in the shower.

Once in the shower it was no time before I began having “real” contractions. They started in the front and wrapped around to my back. They were immediately more uncomfortable than the pre-labor I had been having for 3 weeks. I tried to be conscious of the energy of each contraction and rest in the knowledge that they were what was opening my cervix and bringing my baby to me. I had a great time in the shower! I prayed for a safe birth, sang to the baby and told it how I couldn’t wait to meet it, and fantasized a little about what the day would bring!

Brandon came home, and we set about getting our stuff together and readying the house for our friend Rebecca who would be coming to take care of the dogs for us. We made some phone calls and assured everyone that we would let them know when we had any news. During all of this I had to pause every 7 minutes or so to concentrate on my current contraction. They were becoming a bit more difficult to cope with and I was unable to continue any productive activity during them.

At 11:50am I called Shirley, my doula, to update her on our progress. I let her know that Brandon and I were enjoying laboring alone together for now and that we would like to be alone for a little while longer. I agreed to check back in with her in a little while to let her know when to come to the house. When I got off the phone, Brandon and I discussed how we would decide when to tell her to come. Nadene, my midwife, told me that morning to come to the hospital when my contractions were 5 minutes apart for an hour. I guess we figured we would call Shirley sometime during that “hour”. We called her, instead, around 12:05 when we realized that in the last 30 minutes I had gone from having contractions that were 7 minutes apart to 3 minutes apart and they were lasting 1 ½ to 2 minutes each. I never had 5 minute apart contractions.

By the time Shirley arrived, I was unable to talk through the contractions. If I happened to be standing during the “break” in between contractions, the onset of the next one would drive me to my knees.

I vomited a couple of times (surprisingly, it felt great), and the dogs became very attentive to me. I was vocalizing uncontrollably; kind-of a low-pitched moan. I coped well by getting louder and louder! I felt so powerful!

We continued to labor in my living room for about 30 minutes when I heard Shirley tell Brandon “If she does this a couple more times we need to go!” I didn’t really comprehend what she was saying, though. All I could think was “where did my break go?” Shirley and I were noticing the same thing… My contractions were now 2 minutes apart and lasting 2 minutes each! Literally, I took one breath after the contraction and the next one would start. Brandon told me later that I went through all of the Bradley Method “emotional signposts” in 20 minutes.

The next thing I remember was Shirley telling me to stand up and hug her. She would support me while we made our way to the car (only about 30 feet). Fortunately I got a few contractions with about a 30 second break in between, so it only took 2 to get me to the car! I prayed hard that I wouldn’t have any contractions in the car. Praise the Lord, I only had one on the 1 ½ mile trip to the hospital.

When we got out of the car, I promptly had a contraction and vomited in the ER parking lot (in a small wastebasket I had brought with me). Looking back, I have to laugh at the show I must have put on for the folks in the ER waiting room. While waiting for someone to take me up to L&D, I had several very LOUD contractions. When we first walked into the waiting room, I was hit with a particularly “good” one. Shirley and Brandon were just far enough away that I couldn’t reach anyone to lean on, so I hit my knees and held on to a chair while I moaned loudly. When the contraction was done, I looked up to find a wheelchair and about 10 hospital staff-members standing around me. Apparently they were afraid I was going to birth the baby in the waiting room. Boy, the inhibitions you lose during labor!!

It took us a while to get up to L&D as I refused to sit in the wheelchair. The nurse led us up to the 3rd floor wheeling the empty chair and patiently waiting for me through each of my contractions. When we got to our room, I vomited. I spent a few minutes laboring on the floor.

The nurses, per hospital policy, had to get a 15 minute “strip” of the baby’s heartbeat, so I had to get into the bed for a little while. Because I had been vomiting, Nadene decided to give me some IV fluids. She promised she would run them in fast and unhook me. By the time they were done getting the baby’s heart rate on record, the IV was unhooked. In the meantime, Nadene checked me. I was 6 cm dilated, fully effaced, and the baby was at 0 station!

I had requested a room with a tub for pain management. When we arrived, though, there wasn’t one available. Nadene told me that they were cleaning one, and we could move as soon as it was ready. I wanted to be in hot water, though, so we decided I could wait out the cleaning staff in the shower. She said she was going to go see a couple of patients and would come check on me in about an hour. Once I reached 8 cm, she wouldn’t leave until after the baby was born.

I got into the shower; once again I was on my knees. The hot water felt amazing on my back! At one point I could feel the baby’s head turning in my pelvis. I heard my voice yelling “Stop!” It hurt, but I couldn’t express anything. All I could do was tell it to stop! I had another contraction and told Shirley that I needed to poop. She told me to go ahead because we were in the shower and it would just wash away. My next contraction, I was pushing! I couldn’t control the urge. The nurses called Nadene back to my room and helped me to the bed. I guess they didn’t want me to have the baby in the shower. I asked Brandon later how long I was in the shower. He said 10 minutes max! I went from 6 cm dilated to pushing in about 15 minutes!

I have heard that in a drug-free birth, you will prefer either contractions or pushing. I did
not prefer pushing. After I felt the “ring of fire”, I was ready to quit. I think I actually experienced a 10 on the pain scale. I had always thought that was reserved for ripping off an arm, or something. Fortunately, when I got to the bed and really started pushing, the baby was already crowning. The nurse got a mirror so I could see the head. It was good to take a peek, but there was no way I could watch myself give birth, so I had her take it away.

I pushed a few times half-heartedly. The nurse was having a very hard time finding the baby’s heartbeat. When she did, we realized the baby was having heart rate decelerations in the 80’s when I pushed and the heart rate was not going back up between contractions. Nadene made eye contact with me and told me I had to stop playing around and push the baby out NOW. So I pushed. Hard. I thought it felt better and better the harder I pushed. Nadene cut a small episiotomy, and the next thing I knew, the head was out. I pushed again and our baby was born. She came out with her hand by her face and the umbilical cord wrapped around her neck and her body. It was 2:51 pm. Less than 5 ½ hours from the time my water broke.

Brandon announced to me that we had given birth to a baby girl, and Nadene handed her to me.
We held her uninterrupted for more than an hour. The baby nurse then took her only five feet away to weigh, measure, and bathe her. She was 8 pounds 8 ½ ounces and 21 inches long. We named her Eden Blythe.

I could not have had a more wonderful, beautiful birth experience if I had written it myself. It was such a supernatural experience. Brandon said and did all of the right things at the right times. He was a wonderful coach and partner (and he still managed to take some fabulous photos!) My doula, Shirley, was great, as well. She really empowered me to trust my body during a very powerful event. My midwife, Nadene, just let me do my own thing and labor. She was exactly how I envisioned a midwife should be. When the situation became a bit more urgent, she was matter of fact and told me exactly what I had to do.

I praise the Lord for the miracle of life and for the way He allowed me to bring this new little one into the world. God is so good!

Eden's Garden offers Childbirth Education in Richmond, VA and the surrounding areas.