Critical Path Network

Childbirth at Evergreen seen as family experience

Childbirth at Evergreen Hospital Medical Center in Kirkland, WA, is viewed as a family experience, rather than a medical event.

To make it a positive experience, the family — rather than hospital protocol — determines the choices made for birth, says Tamara Fitzgerald, NAC, ICCE, LE, lead facilitator in childbirth education at Evergreen.

"There is this balance in the medical care to ensure the best outcomes possible with a focus on the family in terms of their wishes for the birth," explains Fitzgerald.

The balance is created through a comprehensive education program designed to help families make educated choices, and prepare them for childbirth and parenting. Education begins with prenatal classes, continues throughout the hospital stay, is provided directly after discharge with a postpartum visit, and continues throughout the first year of a child's life.

"It ensures that at every part of the parent's development, they have that base of information specific to their phase and the baby's phase," Fitzgerald explains.

Physicians encourage their patients, especially new parents, to attend three prenatal classes at Evergreen: a labor/birth series, an infant feeding series, and a one-day, hands-on class called "A Day About Baby."

"It is part of our collaborative process, for parents have less stress and greater ease when they know what to expect ahead of time," Fitzgerald says.

During the labor/birth series, parents are educated about labor and delivery choices, such as pain medication and relaxation techniques, and they create a written birth plan.

A Day About Baby is unique and fun, Fitzgerald says. During the day-long class, parents receive a life-like doll that is used for lessons about bathing and changing diapers, as well as how to hold a baby, and to calm and soothe a crying baby. Because the baby goes everywhere with parents, the couple must learn how to go through a lunch line in the cafeteria with a baby or use the restroom.

"It is a great role-play piece, and the parents really enjoy it and come away with a prenatal, hands-on experience," Fitzgerald says.

Parents who have children and who are attending the labor coping skill class, which is part of the labor/birth series, learn about any changes that have occurred since they had their last baby.

Also offered to families with children is a sibling class that parents attend with their children. The parents remain in the background while children age 2 to 6 learn about interacting with their new brother or sister and discuss how things might change at home. They learn how to help wrap a baby, play safe games with him or her, and tour the room where the baby will be born. Also, they draw a picture for the baby to hang on the crib when they come to meet their new sibling for the first time. According to Fitzgerald, the sibling class is very popular with families.

The curriculum is shaped by several factors. Recommendations from the Institute of Patient and Family Centered Care are incorporated, and the teaching follows standards on childbirth education issued by the state of Washington. Fitzgerald coordinates curriculum with a clinical nurse educator, and together, they stay abreast of current information.

"Birth doesn't change very much over the years, but certainly what is available to parents does change, and the research to support it; so we take new information and weave it into our curriculum," says Fitzgerald.

Prenatal education is timed to coincide with the various levels of adjustment that parents go through to the thought of a new baby, she adds.

Education is hands-on and continuous once the baby is delivered, because the Family Maternity Center at Evergreen Hospital has rooms where the labor, delivery, recovery, and postpartum stay occur. The value of having the baby room with the parents is that they are able to do the first diaper changes and give the baby his or her first bath. A postpartum nurse is there to answer questions. Also, a feeding specialist/lactation consultant visits every family to help with feedings based on the family's choices.

The hands-on care for the baby is very different from having the baby in a nursery during the hospital stay, and it gives the parents confidence to take the baby home, Fitzgerald says.

In addition to hands-on education, each family is given a DVD titled "Going Home with Your Baby" that was filmed at the hospital. In the DVD, staff and parents discuss all aspects of postpartum care for both the mother and baby. Parents review the DVD with a nurse before leaving the hospital; then, they use it as a reference at home. It contains answers to all types of questions that might arise, i.e., from when a parent should take the baby to the hospital to what a baby's first bowel movement looks like, says Fitzgerald.

Also during the hospital stay, mothers attend a class in their bathrobes with their newborn baby. It is taught by a registered nurse, who is a lactation consultant, and covers a variety of topics, such as umbilical cord care, eye care, and breast-feeding. The classes are small and take place daily. The curriculum follows guidelines from the American Academy of Pediatrics.

Learning continues after discharge with an appointment at the postpartum care center three to four days after the family takes the baby home. Parents and other family members can attend. "It is a clinical safety net for issues that might arise after the birth of the baby," Fitzgerald says.

Parent/baby classes are offered on a weekly basis for one year following the birth of the baby. Parents meet with a group that has babies of a similar age. Groups are divided as follows: families with babies 0-3 months; 3-6 months; 6-9 months; and 9-12 months. The classes are two hours and consist of an hour-long presentation by a parent educator, followed by a time for questions and discussion.

The 0-3 month baby class is offered to families at no charge, because the first three months is a crucial time for parent and infant development, Fitzgerald says. New moms, especially, are integrating the birth experience into their lives, and babies are still womb-oriented and don't yet perceive themselves as separate from the mother; also, they need warmth from a lot of holding, she adds.

According to Fitzgerald, the 0-3 month baby class helps mothers who might be experiencing postpartum mood disorder or depression work through these issues.

Fathering is recognized as a priority in childbirth education, as well, and the program offers a class called "Conscious Fathering."

The maternity education program is continually evaluated and improved through family input. Parents who participate in the prenatal classes together come to a reunion following the birth of their babies, and at that time they provide input on the program discussing what they would like changed — or if there was anything they would have preferred to know in advance.

Feedback is also obtained through a patient/advisory board that rotates members through. Board members share their birth experience at staff meetings with physicians, midwives, educators, and nurses.

The continuum of education works well, says Fitzgerald. Prenatally, families learn the clinical benefits of breast milk and learn the process of breast-feeding. At the Family Maternity Center, once the baby is born, the mothers learn to latch at the baby care class and also have hands-on lessons with a lactation consultant/feeding specialist in their room — and later at the postpartum care center. During the weekly meetings of the 0-3 month baby classes, mothers get further support and education about breast-feeding. As a result of this education, 90% of mothers who deliver at Evergreen Hospital breast-feed their babies.