Making Decisions in Labor
Learning to Predict Accurately
As childbirth professionals we know a family’s ability to manage labor will partly rest in their mastery of comfort techniques. Knowing how to perform comfort measures will be useless to families unless they can accurately predict which technique will be most effective to them at the time. The fluid and shifting nature of labor means we cannot teach hard and fast rules such as “be sure to walk for 30 minutes every hour and follow that with a massage.” Virtual Labor was created to give expectant families the chance to practice making decisions during labor.
While in labor your students will make decisions the same way they make decisions in every day life, they will make predictions. Everyone makes predictions naturally, almost without noticing it, in every decision we make. We base these predictions on: our past experiences, available information, if-then thinking, emotions, myths and simple experimentation (try this and see what happens).
The problem with predictions is that unless we are challenged in our thinking, most predictions will be weakened by bias. Some of these biases and their relationship to labor would be:
Failing to question information from an authority – many women view their health care provider’s word as absolute truth rather than possibility.
Generalizing from a single experience – many women have fears of labor based on one or two women’s stories of their labor.
Uncritical evaluation of common opinion – many women accept the cultural beliefs that labor is unbearable without asking for evidence or seeking other views.
Overvaluing the first prediction that comes to mind – this is the problem of women not being able to let go of a fear that something will happen (such as the pain will just get worse and worse).
There are some activities you can incorporate into your class to help your students learn how to strengthen their predictions by removing some of the biases. Each activity includes a way to work it into your class while discussing labor coping strategies (comfort measures).
Peer Review - Using peer review activities (where students share their thoughts and suggestions about a topic) helps the student challenge her assumptions about labor because she is faced with the fact that others have a different view.
Read a labor story aloud, or have your students share their experience from Virtual Labor. Ask students to offer suggestions for what could have made the labor better. Encourage students to share what they liked and didn’t like from the story.
Think-Aloud Interviews – By asking your students to think out loud as they work through the answer to a question, they will reveal the types of information they used to make the decision. This allows you to redirect the thinking process by adding other bits of information.
Give your students labor “problems” for the coaches to solve. Ask the coach to think through the problem out loud as s/he determines how to assist the mother. Feel free to print a few scenes from the Virtual Labor to use for this exercise. The next step in the scenario doesn’t matter, because your students should be able to come up with some possibilities on their own.
Offer Alternatives – By giving students multiple options to a problem, you prevent one way thinking.
Write a different labor coping strategy or comfort measure on each of 20 index cards and pass them out to your class. As you read different labor scenarios, ask your students to find cards that contain strategies that may be helpful.
More Data – Predictions should be informed. Before you ask your students to determine which comfort measures to use, be sure they have an understanding of what the comfort measures are and how they can be helpful in labor.
Work backwards in a labor game. Instead of giving a scene with options of comfort measures, give your students a comfort measure. Then have them review a list of labor scenes and ask them which ones would be good times to use the comfort measure.
Observation and Experimentation – Give your students time to test information and their assumptions about it.
During a labor rehearsal, ask your students to use various coping strategies or to use them in different ways (i.e. don’t touch the mother this time; don’t speak to the mother this time; always keep one hand on the mother this time). Ask them what was most helpful. Was it what they expected?
Draw Predictions – Find ways to express thoughts and ideas that are not sentence based. Remember, most predictions are made without realizing it, and the labor companions are going to have to act on their predictions during labor. Acting on your prediction is a different skill than choosing what you will do.
Read a labor scenario to your students. Instead of answering the question, have them begin performing on the mother the comfort measures they think would be most helpful.