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Step 9: Childbirth Educator Manual and Comprehensive Essay Exam (CEE) Part 21 point(s)Part II (Essay Exam)This part concentrates on your general knowledge and facilitating abilities. Please note the following:We request that you choose a font color other than black that can be easily read, or enter your responses in italic text. This is to make it easier to separate your responses from the questions. Before entering a response, be sure to place your cursor on a line BELOW the last sentence of the question. Again, this will help to keep your responses separate from the questions and make it easier for your Mentor to read. You do not need to finish this entire Part in one sitting. You should save your work from time to time. Be sure to save your work whenever you finish for a time. While you should keep your responses concise, you may use more space than initially appears below the questions. Part II: Essay Response QuestionsFirst Class: You are ready to teach your very first BirthWorks class series. What is the first question BirthWorks International requests that you ask in the first class of a BWI childbirth education class series?What do you feel is important about this question?What do you feel is that no formal introductions are given in the first class? Obstetrical DrugsWhere do you believe much of the pressure on doctors to use obstetric drugs comes from? What do you believe can be done to decrease the use of drugs in pregnancy, labor, and delivery?Describe how the use of too much Pitocin can lead to uterine inertia and subsequent consequences in labor. Include how you could demonstrate this in class. How will you approach this concept in your classes Multi-sensory visualization – Multi-sensory visualization can be used effectively in your classes. Please define multi-sensory visualizationWrite a sentence including at least two techniques you might use during a class-visualization. Name the techniques you used and explain how they can be effective. 4. Ultrasound – Nancy is 30 weeks pregnant and her doctor tells her he wants to do an ultrasound to get a more accurate due date.a. If Nancy consents, what misconceptions do she and her doctor have about ultrasound?b. At 32 weeks gestation, she notices some spotting of blood from her vagina. Her doctor wants to do an ultrasound and she comes to you in class asking what she should do. What would you say?c. At 34 weeks gestation, an irregular heart rate is heard at one visit and her doctor wants to order a fetoechocardiogram that utilizes ultrasound. In class, she asks what she should do? What would you say to her?Name three reasons when an ultrasound might be indicated in a pregnant woman. 1.2.3.5. Epidurals –Two pregnant women are talking together. One says she plans to have an epidural and the other says she’s heard too much about its risks and is planning to go natural. “What risks?” asks the other woman. “In fact, my friend said her anesthesiologist said it is safe for the mother and baby. Anyway, why feel labor pain if you don’t have to?”a. List seven of the risks her friend could mention. Be sure to address the following in your answer: obstetrical drugs, positioning, beliefs, breastfeeding, the time given in labor, and primal health research.1.2.3.4.5.6.7.b. List three good uses of an epidural.1.2.3.c. How would you respond to the question from your class, “In labor, why feel pain if you don’t have to?” and “Epidurals must be safe since so many women are using them.”d. How can an epidural inadvertently become a spinal? What risks are associated with spinals?6. The Nocebo Effect a. Define,“The Nocebo Effect” and give an example of it being used on a pregnant woman and/or a woman in labor. b. What is a physiological effect of the Nocebo Effect on a pregnant woman and/or a woman in labor? 7. EFM, Due Dates, and Beliefs – Marcy, a first time mother, was seven months pregnant. She interviewed nine doctors with hopes of having a non-interventionist hospital birth. Unable to find an acceptable doctor, she decided to have a home birth with a midwife and a family practice physician for back up. At 41 weeks a nonstress test was reactive. Labor began nine days after her due date with strong, effective, but painful contractions, however progress in dilation was slow and she was becoming exhausted from the work of labor and lack of sleep. Gradually, her labor contractions slowed down and she became discouraged. Her midwife noted some abnormalities in the fetal heartrate and Marcy decided to go to the hospital. At the hospital an external fetal monitor was placed on her abdomen. The tracing showed decelerations. The doctor said that her baby was in fetal distress. He examined her and then said, “If you don’t push your baby out soon, I will have to do a cesarean.” Within the hour, Marcy gave birth vaginally to a healthy seven-pound girl.a. What were Marcy’s choices when she arrived at the hospital?b. What beliefs do Marcy and her doctors have about use of the external fetal monitor in labor?c. What is the definition of a ‘due date’?d. How may Marcy’s belief systems have influenced her birth?e. Would the situation be any different if Marcy was anticipating a VBAC? 8. Non Stress Test – Amanda is 39 weeks in gestation and her doctor wants to perform a Non Stress Test. She knows that a normal due date is plus or minus two weeks of her due date, and she feels regular kicking of her baby. She decides to refuse the test. That night her amniotic sac opens.a. What are some advantages and disadvantages of a Non Stress Test at this point in her pregnancy?b. What are some of her alternatives to the Non Stress Test?c. What cautions should she take now that her amniotic sac has opened? 9. Place of Birth and Beliefs – A woman in your class states that birth should take place in the home. Another woman states that with today’s modern technology, birth is safer in the hospital and that there is no need to take unnecessary risks by staying at home.a. In your opinion, who is right? How might you guide this discussion? b. What BWI philosophy would be most helpful in this discussion? c. Some doctors support home birth and others support only hospital birth. How do you account for this dichotomy of views in the medical profession?10. Exercise and Beliefs – Ann has been teaching gymnastics for several years and runs five miles every day. Now she is pregnant with her first child. She is continuing her exercise regimen throughout her pregnancy to be in good physical condition for the upcoming birth. Friends reassure her she’ll probably have an easy birth since she is in such good shape.a. How do you feel her exercise regimen will help her in this birth?b. How might her belief systems affect her labor?11. Breastfeeding and skin-to-skin contact of mother and baby During your last class you are discussing the advantages of breastfeeding when one of the father’s in the group openly states he does not understand what the “big deal” is. He reveals his 9-year old son from a previous marriage was raised on formula and is perfectly healthy. He also relates that he got to help feed his son with the bottle. His wife says she will try breastfeeding, but she too doesn’t see that it is a “big deal” if it doesn’t work out. She says she has had several friends who couldn’t breastfeed because they were in so much pain they had to stop by the time the baby was two weeks old. Another mother in the group states that she feels like it is VERY important and begins quoting statistics about the incidence of chronic illnesses and starts to passionately reproach the formula companies as “big business”.Write a short dialogue of how you would handle this in class.In terms of primal health, how is “suckling” different from “sucking?” What does this phrase mean to you, “Behavior is place dependent.” What is the physiological significance of mother-baby skin-to-skin contact in the hours after birth and into the primal period? Include birth as an experience of sensory integration in your answer. What can birthing parents do to ensure having skin-to-skin contact with their babies right after birth?What would you say to women who for medical reasons cannot have their baby in the first hours after birth? In your answer include maternal and infant emergencies?Identify some “obstacles to breastfeeding” and write a short dialogue on how you would address these. 12. Grieving and Healing – It is the evening when you are discussing grieving in your class. One man begins to relate his feelings about the previous cesarean of his wife. He tells how helpless he felt in the hospital environment to prevent various interventions from occurring. When he says, “And my wife still blames me for not being strong enough to keep those things from happening,” he begins to cry.a. How might you support him and what might you say?b. If it were a woman, would you do anything differently? If so, what?c. Name the five generally accepted stages of grieving with a short description of each and their pertinence to birth?13. Beliefs: Pelvic FloorA woman in your class says, “I don’t know what to do. I believe in normal, natural birth but my obstetrician herself chose to deliver her baby by cesarean to avoid damage to her pelvic floor. I don’t want to damage my pelvic floor but I don’t want the pain from major surgery of a cesarean either. And my friends who gave birth vaginally say they had vaginal tears that made peeing very painful at least a week after birth!”a. How are her concerns affecting her mind? Do you believe her concerns are valid?b. How would you respond to her in a class setting?14. Doulas – Andrea is contemplating hiring a doula to be with her during labor. Her husband feels it is unnecessary and agrees with the doctor that nurses in the hospital are already trained to help women in labor. He further comments that although having additional help may enhance a birth experience, it isn’t absolutely necessary and would cost more money anyway. Besides, he will be there to help out when the going gets rough.a.List three advantages of having a doula at a birth. 1.2.3.b. Write a short dialogue of how you might introduce the value of having a doula at a birth in a class setting. Include specific questions you might ask and/or any creative techniques to begin discussion?c. It is only in this century that men have begun attending births with their wives/partners. How do you view the role of the father/partner at birth? List three questions you might ask in class about the role of men at birth?1.2.3.15. Intravenous in labor – A woman interviews a doctor who tells her that he requires an IV during labor to provide calories necessary for the work of labor and also in case of hemorrhage.a. Do you believe these are valid reasons for an IV? Why or why not?b. What are the advantages and disadvantages of an IV during labor?c. What are some alternatives?16. Types of Learninga. Describe the difference between didactic and experiential (emotional) learning.b. Knowing that the impact of learning is deeper when learned in an emotional context, give three examples of how you will make your classes experiential.1.2.3.c. What is the difference between education and educare? Describe which one is facilitation in nature and its physiological effect. 17. Medical Malpractice – Many doctors are never sued for medical malpractice but malpractice does occur. It is cited as one of the most important factors contributing to the practice of defensive medicine and the high cesarean rate. However, this practice of defensive medicine has not led to a decline in the rate of neonatal mortality and morbidity.a. Define medical malpractice and explain what causes it in your opinion.b. Describe 3 ways in which doctors/hospitals, consumers, and childbirth educators could help to decrease the practice of defensive medicine1.2.3.19. Birthing Language – Current birthing language in most hospitals includes such words as “trial, PUSH!, stages, patient, confinement, inadequate, observe, hurry, lie down, monitor, procedure, hours, centimeters, emergency, risk, distress and pain.”a. List at least 10 new birthing vocabulary words that you would rather hear in any place of birth.b. What impact do you believe these words have on health care providers and women in labor?18. Oxygen Use in Labor – Some childbirth videos show healthy laboring women wearing oxygen masks for fetal distress, accompanied by statements that the woman is wearing the mask to give her baby more oxygen. The scene depicted feels like an emergency and heightens emotions of fear and feelings of dependency.a. Why is the use of oxygen of little help to the baby in the above scenario?b. Can you think of an alternative the birth team could suggest to the woman to relieve the possible fetal distress?19. Optimal Pelvic Positioning – The supine position in labor is still commonly seen in hospitals today despite the fact that studies show that women who are free to move around tend to have shorter labors.a. What do you believe is the reason most women in hospitals today labor and birth in supine positions?b. Describe five physiological and psychological benefits of mobility during labor?1.2.3.4.5.Two positions a woman can use in labor to relax her pelvic floor musculature and help labor to progress are the sidelying release and the forward leaning inversion. Describe each and how they are effective in labor. Sidelying release2. Forward Leaning Inversiond. Name each of the BirthWorks “Four Principles of Optimal Pelvic Positioning with a short description of their value in birth.”1.2.3.4.e. List four positions that keep the pelvis anterior, allowing for the baby to pass in front of much of the pelvic floor musculature?1.2.3.4.20. Pelvic Bodywork – Imagine that you are teaching the pelvic clock exercise to your class. Describe in detail how you would introduce it, explain it, and demonstrate it. Include important points that need to be remembered.21. Pain and Breathing Patterns – A woman has just gone into labor with her first child. As the contractions become very intense, she finds herself wanting to yell out, but she suppresses it, fearing loss of control and embarrassment. A nurse walks in calmly and sees her concentrating on breathing patterns. After remarking on how well she’s doing now, she reminds her that when the pain becomes too bad, she can ask for an epidural.a. In what ways do you feel performance anxiety affects a woman’s labor?b. How might the nurse’s comments affect the woman’s labor?c. In your opinion, are breathing patterns helpful in labor? If so, how? If not, what would you recommend instead?d. How can feeling pain help a woman in her labor?22. Effective Communication – One of the women in your class, who is at 36 weeks gestation, says she feels afraid and intimidated by her doctor. She says that at her prenatal visits she feels rushed and if she does say something, it feels like the doctor is giving her only half of his/her attention and by the time she leaves she feels unsatisfied and frustrated that her questions were not really answered.a. List three questions you might ask this woman in your class to help her find her own answer about what to do.1.2.3.b. How do you think the doctor is feeling? The woman?23. Induction – Amy is pregnant with her first baby and has chosen a female obstetrician because she feels that as a woman, she can relate to her better. As she approaches 39 weeks gestation she is feeling very uncomfortable. Her OB suggests they schedule an induction because it looks like she has a big baby. Amy has taken your class and is very well informed as to the risks of a scheduled induction. Her OB assures her that they will start out with the most non-invasive procedures and recommends Cervadil, which she proudly states is what helped her get her pregnancy over with when she was so uncomfortable towards the end.a. What does this doctor seem to believe about pregnancy, labor and birth?b. What are ways to induce labor and what are their risks/benefits?c. Name some good medical indications for induction?24. Careers and Parenthood – Gail, a computer programmer, and her partner had been married 7 years before becoming pregnant. They were concerned about children interfering with their comfortable lifestyle and the effect they would have on their careers. Gail’s mother told her that her births were very painful and didn’t understand why Gail didn’t want to be “put out” like she was. Gail’s two-year-old son was born by cesarean section due to failure to progress. She is now in your class, in her sixth month of her second pregnancy and wishes to have a VBAC.a. What do you think may have led – or contributed to – Gail having a cesarean birth the first time? How would that influence your work with her now?b. Describe an embedded command? Give examples of at least three you might use in a visualization to help her have more faith in her body’s ability to give birth in a VBAC.c. What would you say to her when she tells you that hospitals in her area will no longer accept VBAC clients, as it is too dangerous?25. Nutrition – Nutrition for a pregnant woman is not much different from nutrition for everyone else. The basic advice remains the same: Eat a variety of whole, clean, least processed plant foods, and eat in moderation. In addition, pregnant women need additional nutrients and calories from major food groups that include protein, carbohydrates, healthy fats and fiber in addition to a prenatal vitamin that contains iron, calcium, and folic acid. All people should reduce their intake of refined flour and sugar, saturated fats, and trans fats.a. By the third trimester of pregnancy, what are the recommended changes in diet recommended for pregnant women.b. What is the reason that pregnant women take folic acid before they are pregnant, and during the first trimester? If so, how much is recommended?c. Iodine, B12, and Vitamin D are three micronutrients in a prenatal vitamin that are difficult to obtain from a healthy whole foods plant based diet and are most reliably obtained from a supplement? Explain the importance of each for a pregnant woman.d. What is the importance of drinking plenty of water in life but especially in pregnancy?e. What is the meaning of holistic nutrition? Give examples of good and not so good holistic nutrition for a pregnant woman?f. Explain why each of the following are important for all people and especially pregnant women?a. Nutritional value is greatest when food is consumed closest to its natural state. b. Choosing complex carbohydrates (whole grains and foods) rather than refined carbohydrates (sugars and refined starches) benefits health.c. Choosing fresh fruits and vegetables benefits health and well-being. g. How do you plan to put good nutrition into practice in your classes? 26. Genital Herpes – In obstetrical care every attempt is made to ensure a healthy mother and baby. Protocols for treating pregnant women in labor who have active Herpes are currently controversial depending on hospital policies. Some believe that the risks of cesarean surgery are greater than the risk of the baby becoming infected with Herpes and recommend a vaginal delivery. Others believe that cesareans should be performed on all women in labor who have active Herpes lesions just to be safe.a. Write a paragraph on how you would introduce this topic in class and include at least five questions you would ask class participants.1.2.3.4.5.b. What does current research show about the risks of a cesarean and the risks of a baby contracting Herpes? According to research, which risk is greater?c. Current research advises that if there is an active lesion at the time of labor, a cesarean section is recommended unless the amniotic membrane has ruptured for more than (choose one: 2, 4, 6) hours. 27. Repeat Cesarean – A woman in your class chooses to have a repeat cesarean in spite of all the information she has received from you. Another woman who attempted a VBAC has a repeat cesarean. How would you as an instructor support them? How do you feel about inviting either of them back to talk to participants during the last class of another series?28. PhilosophiesList three of your favorite BirthWorks philosophies and describe what they mean to you and your teaching BirthWorks classes. 1.2.329. What is a special quality you have that you feel will benefit people in your classes?Congratulations! YOU HAVE COMPLETED YOUR EXAMPlease send your exam to your Mentor following the instructions for using the Upload File button and expect feedback from her. ................
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