- Email: [email protected]
Establishing Prenatal Classes In a Small Community: Overcoming the Opposition
trends Establishing Prenatal Classes In a Small Community Overcoming the Opposition T h e author established the first expectant parent classes t o be offered in her S T J I ~ rural ~ ~ , co m n u n ity. T h e reasons for the .medical staff’s initial opposition to the class are explored, steps taken to overcome this opposition are explained, ?iretbods of publicizing the class are presented, and reactions of the vredical staff to the class arc discussed. Resources and the class outline are included.
T h e nurse who establishes new health programs in a small, rural community may encounter opposition from some members of the community and the local health care team. T h e opposition she foresees or encounters may discourage even the courageous from pursuing an idea for improvement. Yet if she feels that a need for a new program exists, and some members of the community agree, and if she has perseverance and enthusiasm, it is possible to almost single-handedly bring the program into being. T h e author accepted the task of establishing the first prenatal class ever offered in such a community: a rural, midwest town with 10,000 residents, and a 120-bed hospital where 250 deliveries are done each year. T h e class was organized without initial endorsement from the medical community or hospital personnel. There was even some open opposition. Eventually, however, most of the opposition approved the project, especially the results. T h e impetus for this class took shape in the fall of 197 1. Several couples expecting their first babies requested prenatal classes by contracting the hospital and seven local general practitioners. Most of the physicians in the community were either neutral or opposed to prenatal classes. T h e hospital administrator felt there was a need for prenatal 44
T E R R Y S T E I N , R N , BSN
instruction but, due to the physicians’ attitudes, was unwilling to establish such a class. H e chose to remain neutral on the issue. T h e expectant parents next approached the community school board. I then received a call from the Director of a local vocational-technical school, who asked me (a nurse in the hospital’s Department of Obstetrics and Gynecology) to organize and teach an adult course in prenatal care. I told the Director that I was very interested in teaching the course, but that my first responsibility was to the hospital and I would like approval of my employer. T h e Director called the Hospital Administrator and was advised that my employment at the hospital would not be affected in any way if I taught the adult course. T h e Administrator also stated that the class would be welcome to tour the area of the hospital that would interest them as expectant parents. Physician Opposition
Positive attitudes from the community, physicians, and hospital personnel are of utmost importance in initiating an expectant parent class. I tried to determine and overcome any objections before the class began. This was the important first step in initiating the program. Major opposition seemed to come from the physicians, and if patients are to be referred to such a class, success depends greatly on a positive (if not enthusiastic) response from the physicians. It seemed that the physicians opposed the program because they were not aware what the course content would be. Several physicians questioned whether the information to be dealt with would Seprembcr/Octobcr 1973 ]OGN Nursing
conflict with their beliefs. They thought their patients might become “riled up” and anxious. The strongest opponent contended (and still does) that the less the patient knows about what is happening to her during pregnancy, labor, and delivery, the better off she will be. This physician discouraged his patients from talking to anyone about pregnancy and childbirth and from reading any educational information on the subject. H e went to the school board to try to stop the classes. To allay their fears concerning course content, I formulated and submitted a syllabus (see Appendix I) of the proposed expectant parent class to the medical staff and the hospital administrator for approval. I stated the objectives of the expectant parent class so that they would be clear and acceptable to the physicians. The objectives of the class were simply “helping expectant parents gain self-confidence and security in their new roles by overcoming some of the anxieties related to pregnancy, childbirth, and newborn care.” Gaining positive attitudes toward the class from the members of the community health services was an inadvertent goal. The class was eventually accepted by all but one of the physicians. Following acceptance, the course syllabus was gradually expanded to encompass more information and current trends (see Appendix 11). Further assessment of the physicians’ views revealed their concern that the classes might jeopardize the close rapport these general practitioners have with many of their patients. Expectant parent classes would mean the involvement of a third party: the nurse instructor. Yet, many physicians lack sufficient time to adequately answer all the September/October 1973 JOGN Niirsing
questions which are very important to the pregnant patient. When I carefully explained to the physicians that the proposed classes would not replace but would supplement antepartum office visits, their opposition diminished somewhat. One of the physicians questioned whether teaching the prenatal class is a nursing function. This idea brought to mind the archaic thought that a nurse is a servant-that she lacks an education and a professional opinion. The physician suggested that I contact a reputable organization and use the organization’s information and format for mother-baby care classes. T o satisfy the physician, I used the well-known baby care information from the local American Red Cross chapter as an outside resource, even though teaching aids from other substantial and well known sources were already being incorporated into my presentation. It became evident to me that the physician who is less informed obstetrically, opposed expectant parent classes because he does not see the benefit of patient participation in delivery. One physician, of several who routinely utilized ether anesthesia, strongly opposed these classes because I planned to incorporate psychoprophylactic principles and techniques. H e has continued to resist prenatal classes and thus far has even refused to acknowledge the existence of the expectant parent classes. However, several of his colleagues now rely more on this prepared childbirth procedure. Favorable Factors
In this particular situation, members of the community favored the classes. They were the ones who went from physicians to hospital and then to 45
EDITOR’S NOTE One physician’s reactions t o t h e author’s classes are expressed i n the following letter from R. E. Dunshee, MD, Chief of Staff a t the hospital which employed the author when she established t h e p:enatal class. To the Editor: When Ms. Stein first announced plans for her prenatal class, it was greeted with mixed enthusiasm by our medical staff. It ranged from lukewarm enthusiasm t o outright opposition. My personal feeling was lukewarm enthusiasm. After her first class m y enthusiasm began t o increase, and I began encouraging my patients t o attend these classes. After the second class I became an enthusiastic supporter of them and now request m y patients’ attendance a t these classes. It is my experience since the advent of these classes that m y patients now approach delivery with enthusiasm and expectation rather than fear and trepidation. During the labor period patients are much more cooperative and relaxed. Their labor is shorter and deliveries almost entirely spontaneous; i n only a few instances are forceps required. The length of labor has been noticeably reduced. Certainly an informed, cooperative patient is much more t o be desired than an uninformed, uncooperative one. I can unequivocally state that I a m now an enthusiastic supporter of these classes.
R. E. Dunshee, MD
the school district to inquire about establishing class. Although neutral on the issue, the hospital offered support for the program by lending me a Birth Atlas. T h e atlas was, however, given to me with the understanding that I should not tell anyone where I received it lest there be “trouble.” My employer would not back me up publicly. Because of this response, the director of the school where I was to teach sent a letter to the hospital administrator reiterating the administrator’s promise that my position at the hospital would not be jeopardized. Information for the course was obtained from current references and available community resources. T h e result was a fairly comprehensive course on pregnancy, introduction to psychoprophylactic techniques, labor, delivery, and newborn care. References used are listed under “Resources.” Informing the Public T h e next step in initiating this program was to 46
inform the public of the class. Ideally, physicians would tell patients about the availability of the class. In this situation (because of the physicians’ initial objections), referrals were not initially given. For the first series of expectant parent classes, I chose to mail a personal letter about the class to prospective parents instead of asking the physicians to do this. I obtained a list, from the hospital laboratory, of pregnant women who recently had a prenatal blood work-up. T h e letters proved a very effective means of informing pregnant patients of the class. After the second series of classes, most of the physicians were more than delighted to give their patients the informative letters (see Appendix 111) during routine antepartum visits. Local radio stations and newspapers also helped encourage patients to attend. Radio stations will announce noncommercial services and programs (such as the prenatal classes) that are available to the public. There is no charge for a public service announcement (PSA). A PSA is on the air for 10, 20, 30, or 60 seconds and should be written accordingly. A typewritten, double-spaced announcement is submitted to the radio station about two weeks in advance of the program. Many stations also welcome your ideas for programs about community services. You might suggest an authority on the subject, a project director or participant in your program, who could be interviewed by a “talk show” host, and provide an outline of information that could be covered during the show. T h e information should interest many listeners and should be appropriate for a radio talk show. hTewspapers also print public service announcements as did our local university’s student paper. These announcements are also submitted typewritten and double-spaced, with the writer’s address and telephone number. All local media are avenues for publicity and the public relations department of a radio station or newspaper is happy to supply details on their requirements for news announcements. To inform the news media of the prenatal class, I telephoned the two radio stations and three newspapers in the community and requested that they use the small article I composed as a community service announcement (see Figure 1). In September/October 1973 IOGN Nursing
addition, the local school board advertised this and other adult education classes in a full-page newspaper ad just prior to the time for class registration. Along with radio stations and newspapers, local television stations often are happy to provide time for PSA’s and/or news announcements. Some even have a community “bulletin board” service. Comments
To date, I have taught the prenatal course six times within 2 1 months. Over 90 couples have completed the course; all, except members of the first class, were recommended by physicians; all paid the school board a small tuition; and the majority subsequently delivered in this community’s hospital. About 30% were to have their second or third baby when they attended these classes. Eight couples attended the first class; 2 3 attended the most recent class. T h e physicians have shown a growing acceptance of the class and the psychoprophylactic theories taught. Six now encourage all of their primigravidas and many multiparas to attend. One of the physicians recently told me that his patients actually do better in labor and are less apprehensive because they have, through the prenatal class, acquired a basic understanding of childbirth, know what to expect, and have learned how to work effectively with their contractions. Another physician said he feels that patients who have taken the classes look forward to labor and delivery without fear and dread. In general, the physicians came to realize that expectant parent classes result in patients who are happier because their curiosity is satisfied with knowledge, because they are more relaxed and cooperative in labor, and because they are better able to participate fully in delivery. Appendix I: Syllabus for Prenatal Classes TO: Medical Staff FROM: Terry Stein, RN SUBJECT: Prenatal Classes DATE: September 21, 1971 OBJECTIVE: To help expectant parents gain self-confidence and security in their new role by overcoming some of the anxieties related to pregnancy, childbrith and newborn care. This will be accomplished by helping them acquire an insight and basic understanding of the following:
I. General Hygiene September/October 1973 JOGN Nursing
Parental Instruction Classes Organized Classes for expectant parents are being held a t the Maryville R-I1 VocationalTechnical School from 7 to 9 PM each Monday. T h e classes will continue through Aug. 7. Cost is $6 per Family unit. Either or both parents can attend at the same price. The Red Cross approved classes are under the direction of Ms. Terry Stein, R. N., a member of The Nurses Association of The American College of Obstetricians and Gynecologists. Ms. Stein urges all interested persons to attend the class Monday night. Figure 1. Example of newspaper article that newspaper publishers will run as a public service.
A. Sleep, rest, exercise, relaxation, breast care, weight control, diet-all as suggested by their physician. B. The importance of maintaining routine visits with the doctor. C. Obtaining prenatal blood work during pregnancy. 11. Fetal Growth and Development (Visual aids will be used to exemplify this and will consist of:) A. The Birth Atlas ( ublished by the Maternity Center Association) ; the A l a s shows pictures from conception through the various stages of fetal development and birth. B. Human Development Models (set of 5 models) illustrates the stages of development from conception through the Sth month. 111. Labor and Delivery A. What is labor; what happens to the body during contractions? B. Practice abdominal breathing. IV. The Hospital Stay A. What to bring to the hospital B. When to come to the hospital 1. Discuss with physician in advance 2 . Guidelines a. regular contractions b. ruptured bag of water c. bleeding C. Tour of hospital V. Care of the Newborn A. Layette B. Baby bath demonstration C. Formula preparation D. Breastfeeding It is my feeling that classes for expectant parents are needed in this community and, through a combined effort, an “ideal” program can be established. If you have any comments about these classes please inform me of them. Thank you.
Appendix 11: Expanded Syllabus for Prenatal Classes OBJECTIVE: T o help expectant parents gain self-confidence
47
and security in their new role by overcoming some of the anxieties related to pregnancy, childbirth, and newborn care. A basic understanding of the following will help to accomplish this objective. FIRST WEEK: 1. Introduction to psychoprophylactic technique (Lamaze or conditioned response) 2. Pregnancy a. body changes b. discomforts c. emotional aspects d. danger signs e . nutrition film (Nine Months to Get Ready from the State Division of Health) 3. Growth and Development of Pregnancy 4. Exercises SECOND WEEK: 1. Labor a. three stages of labor including sign and symptoms of each stage b. visual aids i. cervical dilatation chart ii. knit uterus 2. Exercises T H I R D WEEK: 1. Labor reviewed 2. Delivery film ( A Family is Born from the Syntax Corporation) 3. Exercises F O U R T H WEEK: 1. Formula feeding 2. Breastfeeding 3. Films (Baby Feeding for N e w Mothers and Phenomena o f Early Development from Ross Laboratories) 4. Exercises FIFTH WEEK: 1. Baby bath film (Baths and Babies from Johnson & Johnson) 2. Diaper changing and practice with Kimbies and Pampers 3. Holding an infant 4. Layette SIXTH WEEK: 1. Tour of St. Francis Hospital (maternity area primarily) 2. Discussion of what to bring to the hospital It is suggested that you purchase either or both of these paperbacks: Karmel, Thank You, Dr. Lamaze, Doubleday, 1959, and Chabon, Awake and Aware, Dell, 1969. Both of these books can be purchased a t the NWMSU bookstore for 954.
Appendix 111: Promotional Letter for Expectant Parents Adult Education Class Dear Expectant Parents: Classes for Expectant Parents (Prenatal Classes) will be available to you starting July 10, 1972, at the Maryville Area Vocational-Technical School located next to the high school. It is our hope that these Red Cross approved classes will enable you to gain insight into your pregnancy and to be self-confident as a new parent. The classes will meet on Monday evenings from 7:OO to 9:OO PM for 5 weeks. The registration fee is $6.00 per family unit. All expectant parents, expecially those expecting their first baby, are encouraged to attend. These classes are intended to give you a basic understanding of conception, the growth of the baby, the numerous changes taking place during your pregnancy, and the process of labor and delivery. You will practice Lamaze breathing mechanisms that can help you during delivery, tour the hospital’s maternity floor, and practice diapering and bathing a baby as well as preparing formula and breastfeeding. For fulther information contact the Maryville Area Vocational School at 582-3197 or Terry Stein, RN, at 582-3098. Sincerely yours, Terry Stein, R N
Resources Dickinson-Belske: Birth Atlas, New York, Maternity Center Association Publications Nystrom. A. J., et al.: Human Development Models. Chicago, Subsidiary of Field Enterprises Educational Corporation Lidov, A.: Your Baby and You. Columbus, Ohio. Ross Laboratories Publications, 1971 Beck, F. W.: P r e g m c y in Anatomical Transparencies. “Trans-Vision” Milprint, Inc., 1962 Chabon, I.: Awake and Aware. New York, Dell Publishing Co.. 1966 Karmel, M.: Thank You, Or. Lamaze. Philadelphia, J. B. Lippincott Co., 1959 “ ‘Prepared Childbirth’: From Classroom to Delivery Room.” Kansas City Stm, April 11, 1571 “HOWto Make a Knitted ‘Uterus’ for Teaching.” Briefs, Maternity Center Association Publications, 1963 Cervical Dilatation Chart, Columbus, Ohio, Ross Laboratories Publications A Family Is Born. Syntex Co. Publications Baby Feeding for New Mothers. Columbus, Ohio, Ross Laboratories Publications Both and Babies. New Brunswick, N.J., Johnson & Johnson Publications Phenomena of Early Development. Columbus, Ohio, Ross Laboratories Publications
Ms. Stein is Head Nurse in the Deparmient of Obstetrics and Gynecology of a community hospital in northwest Missouri. She serves as a &st lecturer on obstetrics at Northwest Missouri State University in addition to teaching prenatal classes. She holds a BSN from the University of Iowa and is a Member of NAACOG.
Septernber/October 1973 JOGN Nursing
T h e nurse who establishes new health programs in a small, rural community may encounter opposition from some members of the community and the local health care team. T h e opposition she foresees or encounters may discourage even the courageous from pursuing an idea for improvement. Yet if she feels that a need for a new program exists, and some members of the community agree, and if she has perseverance and enthusiasm, it is possible to almost single-handedly bring the program into being. T h e author accepted the task of establishing the first prenatal class ever offered in such a community: a rural, midwest town with 10,000 residents, and a 120-bed hospital where 250 deliveries are done each year. T h e class was organized without initial endorsement from the medical community or hospital personnel. There was even some open opposition. Eventually, however, most of the opposition approved the project, especially the results. T h e impetus for this class took shape in the fall of 197 1. Several couples expecting their first babies requested prenatal classes by contracting the hospital and seven local general practitioners. Most of the physicians in the community were either neutral or opposed to prenatal classes. T h e hospital administrator felt there was a need for prenatal 44
T E R R Y S T E I N , R N , BSN
instruction but, due to the physicians’ attitudes, was unwilling to establish such a class. H e chose to remain neutral on the issue. T h e expectant parents next approached the community school board. I then received a call from the Director of a local vocational-technical school, who asked me (a nurse in the hospital’s Department of Obstetrics and Gynecology) to organize and teach an adult course in prenatal care. I told the Director that I was very interested in teaching the course, but that my first responsibility was to the hospital and I would like approval of my employer. T h e Director called the Hospital Administrator and was advised that my employment at the hospital would not be affected in any way if I taught the adult course. T h e Administrator also stated that the class would be welcome to tour the area of the hospital that would interest them as expectant parents. Physician Opposition
Positive attitudes from the community, physicians, and hospital personnel are of utmost importance in initiating an expectant parent class. I tried to determine and overcome any objections before the class began. This was the important first step in initiating the program. Major opposition seemed to come from the physicians, and if patients are to be referred to such a class, success depends greatly on a positive (if not enthusiastic) response from the physicians. It seemed that the physicians opposed the program because they were not aware what the course content would be. Several physicians questioned whether the information to be dealt with would Seprembcr/Octobcr 1973 ]OGN Nursing
conflict with their beliefs. They thought their patients might become “riled up” and anxious. The strongest opponent contended (and still does) that the less the patient knows about what is happening to her during pregnancy, labor, and delivery, the better off she will be. This physician discouraged his patients from talking to anyone about pregnancy and childbirth and from reading any educational information on the subject. H e went to the school board to try to stop the classes. To allay their fears concerning course content, I formulated and submitted a syllabus (see Appendix I) of the proposed expectant parent class to the medical staff and the hospital administrator for approval. I stated the objectives of the expectant parent class so that they would be clear and acceptable to the physicians. The objectives of the class were simply “helping expectant parents gain self-confidence and security in their new roles by overcoming some of the anxieties related to pregnancy, childbirth, and newborn care.” Gaining positive attitudes toward the class from the members of the community health services was an inadvertent goal. The class was eventually accepted by all but one of the physicians. Following acceptance, the course syllabus was gradually expanded to encompass more information and current trends (see Appendix 11). Further assessment of the physicians’ views revealed their concern that the classes might jeopardize the close rapport these general practitioners have with many of their patients. Expectant parent classes would mean the involvement of a third party: the nurse instructor. Yet, many physicians lack sufficient time to adequately answer all the September/October 1973 JOGN Niirsing
questions which are very important to the pregnant patient. When I carefully explained to the physicians that the proposed classes would not replace but would supplement antepartum office visits, their opposition diminished somewhat. One of the physicians questioned whether teaching the prenatal class is a nursing function. This idea brought to mind the archaic thought that a nurse is a servant-that she lacks an education and a professional opinion. The physician suggested that I contact a reputable organization and use the organization’s information and format for mother-baby care classes. T o satisfy the physician, I used the well-known baby care information from the local American Red Cross chapter as an outside resource, even though teaching aids from other substantial and well known sources were already being incorporated into my presentation. It became evident to me that the physician who is less informed obstetrically, opposed expectant parent classes because he does not see the benefit of patient participation in delivery. One physician, of several who routinely utilized ether anesthesia, strongly opposed these classes because I planned to incorporate psychoprophylactic principles and techniques. H e has continued to resist prenatal classes and thus far has even refused to acknowledge the existence of the expectant parent classes. However, several of his colleagues now rely more on this prepared childbirth procedure. Favorable Factors
In this particular situation, members of the community favored the classes. They were the ones who went from physicians to hospital and then to 45
EDITOR’S NOTE One physician’s reactions t o t h e author’s classes are expressed i n the following letter from R. E. Dunshee, MD, Chief of Staff a t the hospital which employed the author when she established t h e p:enatal class. To the Editor: When Ms. Stein first announced plans for her prenatal class, it was greeted with mixed enthusiasm by our medical staff. It ranged from lukewarm enthusiasm t o outright opposition. My personal feeling was lukewarm enthusiasm. After her first class m y enthusiasm began t o increase, and I began encouraging my patients t o attend these classes. After the second class I became an enthusiastic supporter of them and now request m y patients’ attendance a t these classes. It is my experience since the advent of these classes that m y patients now approach delivery with enthusiasm and expectation rather than fear and trepidation. During the labor period patients are much more cooperative and relaxed. Their labor is shorter and deliveries almost entirely spontaneous; i n only a few instances are forceps required. The length of labor has been noticeably reduced. Certainly an informed, cooperative patient is much more t o be desired than an uninformed, uncooperative one. I can unequivocally state that I a m now an enthusiastic supporter of these classes.
R. E. Dunshee, MD
the school district to inquire about establishing class. Although neutral on the issue, the hospital offered support for the program by lending me a Birth Atlas. T h e atlas was, however, given to me with the understanding that I should not tell anyone where I received it lest there be “trouble.” My employer would not back me up publicly. Because of this response, the director of the school where I was to teach sent a letter to the hospital administrator reiterating the administrator’s promise that my position at the hospital would not be jeopardized. Information for the course was obtained from current references and available community resources. T h e result was a fairly comprehensive course on pregnancy, introduction to psychoprophylactic techniques, labor, delivery, and newborn care. References used are listed under “Resources.” Informing the Public T h e next step in initiating this program was to 46
inform the public of the class. Ideally, physicians would tell patients about the availability of the class. In this situation (because of the physicians’ initial objections), referrals were not initially given. For the first series of expectant parent classes, I chose to mail a personal letter about the class to prospective parents instead of asking the physicians to do this. I obtained a list, from the hospital laboratory, of pregnant women who recently had a prenatal blood work-up. T h e letters proved a very effective means of informing pregnant patients of the class. After the second series of classes, most of the physicians were more than delighted to give their patients the informative letters (see Appendix 111) during routine antepartum visits. Local radio stations and newspapers also helped encourage patients to attend. Radio stations will announce noncommercial services and programs (such as the prenatal classes) that are available to the public. There is no charge for a public service announcement (PSA). A PSA is on the air for 10, 20, 30, or 60 seconds and should be written accordingly. A typewritten, double-spaced announcement is submitted to the radio station about two weeks in advance of the program. Many stations also welcome your ideas for programs about community services. You might suggest an authority on the subject, a project director or participant in your program, who could be interviewed by a “talk show” host, and provide an outline of information that could be covered during the show. T h e information should interest many listeners and should be appropriate for a radio talk show. hTewspapers also print public service announcements as did our local university’s student paper. These announcements are also submitted typewritten and double-spaced, with the writer’s address and telephone number. All local media are avenues for publicity and the public relations department of a radio station or newspaper is happy to supply details on their requirements for news announcements. To inform the news media of the prenatal class, I telephoned the two radio stations and three newspapers in the community and requested that they use the small article I composed as a community service announcement (see Figure 1). In September/October 1973 IOGN Nursing
addition, the local school board advertised this and other adult education classes in a full-page newspaper ad just prior to the time for class registration. Along with radio stations and newspapers, local television stations often are happy to provide time for PSA’s and/or news announcements. Some even have a community “bulletin board” service. Comments
To date, I have taught the prenatal course six times within 2 1 months. Over 90 couples have completed the course; all, except members of the first class, were recommended by physicians; all paid the school board a small tuition; and the majority subsequently delivered in this community’s hospital. About 30% were to have their second or third baby when they attended these classes. Eight couples attended the first class; 2 3 attended the most recent class. T h e physicians have shown a growing acceptance of the class and the psychoprophylactic theories taught. Six now encourage all of their primigravidas and many multiparas to attend. One of the physicians recently told me that his patients actually do better in labor and are less apprehensive because they have, through the prenatal class, acquired a basic understanding of childbirth, know what to expect, and have learned how to work effectively with their contractions. Another physician said he feels that patients who have taken the classes look forward to labor and delivery without fear and dread. In general, the physicians came to realize that expectant parent classes result in patients who are happier because their curiosity is satisfied with knowledge, because they are more relaxed and cooperative in labor, and because they are better able to participate fully in delivery. Appendix I: Syllabus for Prenatal Classes TO: Medical Staff FROM: Terry Stein, RN SUBJECT: Prenatal Classes DATE: September 21, 1971 OBJECTIVE: To help expectant parents gain self-confidence and security in their new role by overcoming some of the anxieties related to pregnancy, childbrith and newborn care. This will be accomplished by helping them acquire an insight and basic understanding of the following:
I. General Hygiene September/October 1973 JOGN Nursing
Parental Instruction Classes Organized Classes for expectant parents are being held a t the Maryville R-I1 VocationalTechnical School from 7 to 9 PM each Monday. T h e classes will continue through Aug. 7. Cost is $6 per Family unit. Either or both parents can attend at the same price. The Red Cross approved classes are under the direction of Ms. Terry Stein, R. N., a member of The Nurses Association of The American College of Obstetricians and Gynecologists. Ms. Stein urges all interested persons to attend the class Monday night. Figure 1. Example of newspaper article that newspaper publishers will run as a public service.
A. Sleep, rest, exercise, relaxation, breast care, weight control, diet-all as suggested by their physician. B. The importance of maintaining routine visits with the doctor. C. Obtaining prenatal blood work during pregnancy. 11. Fetal Growth and Development (Visual aids will be used to exemplify this and will consist of:) A. The Birth Atlas ( ublished by the Maternity Center Association) ; the A l a s shows pictures from conception through the various stages of fetal development and birth. B. Human Development Models (set of 5 models) illustrates the stages of development from conception through the Sth month. 111. Labor and Delivery A. What is labor; what happens to the body during contractions? B. Practice abdominal breathing. IV. The Hospital Stay A. What to bring to the hospital B. When to come to the hospital 1. Discuss with physician in advance 2 . Guidelines a. regular contractions b. ruptured bag of water c. bleeding C. Tour of hospital V. Care of the Newborn A. Layette B. Baby bath demonstration C. Formula preparation D. Breastfeeding It is my feeling that classes for expectant parents are needed in this community and, through a combined effort, an “ideal” program can be established. If you have any comments about these classes please inform me of them. Thank you.
Appendix 11: Expanded Syllabus for Prenatal Classes OBJECTIVE: T o help expectant parents gain self-confidence
47
and security in their new role by overcoming some of the anxieties related to pregnancy, childbirth, and newborn care. A basic understanding of the following will help to accomplish this objective. FIRST WEEK: 1. Introduction to psychoprophylactic technique (Lamaze or conditioned response) 2. Pregnancy a. body changes b. discomforts c. emotional aspects d. danger signs e . nutrition film (Nine Months to Get Ready from the State Division of Health) 3. Growth and Development of Pregnancy 4. Exercises SECOND WEEK: 1. Labor a. three stages of labor including sign and symptoms of each stage b. visual aids i. cervical dilatation chart ii. knit uterus 2. Exercises T H I R D WEEK: 1. Labor reviewed 2. Delivery film ( A Family is Born from the Syntax Corporation) 3. Exercises F O U R T H WEEK: 1. Formula feeding 2. Breastfeeding 3. Films (Baby Feeding for N e w Mothers and Phenomena o f Early Development from Ross Laboratories) 4. Exercises FIFTH WEEK: 1. Baby bath film (Baths and Babies from Johnson & Johnson) 2. Diaper changing and practice with Kimbies and Pampers 3. Holding an infant 4. Layette SIXTH WEEK: 1. Tour of St. Francis Hospital (maternity area primarily) 2. Discussion of what to bring to the hospital It is suggested that you purchase either or both of these paperbacks: Karmel, Thank You, Dr. Lamaze, Doubleday, 1959, and Chabon, Awake and Aware, Dell, 1969. Both of these books can be purchased a t the NWMSU bookstore for 954.
Appendix 111: Promotional Letter for Expectant Parents Adult Education Class Dear Expectant Parents: Classes for Expectant Parents (Prenatal Classes) will be available to you starting July 10, 1972, at the Maryville Area Vocational-Technical School located next to the high school. It is our hope that these Red Cross approved classes will enable you to gain insight into your pregnancy and to be self-confident as a new parent. The classes will meet on Monday evenings from 7:OO to 9:OO PM for 5 weeks. The registration fee is $6.00 per family unit. All expectant parents, expecially those expecting their first baby, are encouraged to attend. These classes are intended to give you a basic understanding of conception, the growth of the baby, the numerous changes taking place during your pregnancy, and the process of labor and delivery. You will practice Lamaze breathing mechanisms that can help you during delivery, tour the hospital’s maternity floor, and practice diapering and bathing a baby as well as preparing formula and breastfeeding. For fulther information contact the Maryville Area Vocational School at 582-3197 or Terry Stein, RN, at 582-3098. Sincerely yours, Terry Stein, R N
Resources Dickinson-Belske: Birth Atlas, New York, Maternity Center Association Publications Nystrom. A. J., et al.: Human Development Models. Chicago, Subsidiary of Field Enterprises Educational Corporation Lidov, A.: Your Baby and You. Columbus, Ohio. Ross Laboratories Publications, 1971 Beck, F. W.: P r e g m c y in Anatomical Transparencies. “Trans-Vision” Milprint, Inc., 1962 Chabon, I.: Awake and Aware. New York, Dell Publishing Co.. 1966 Karmel, M.: Thank You, Or. Lamaze. Philadelphia, J. B. Lippincott Co., 1959 “ ‘Prepared Childbirth’: From Classroom to Delivery Room.” Kansas City Stm, April 11, 1571 “HOWto Make a Knitted ‘Uterus’ for Teaching.” Briefs, Maternity Center Association Publications, 1963 Cervical Dilatation Chart, Columbus, Ohio, Ross Laboratories Publications A Family Is Born. Syntex Co. Publications Baby Feeding for New Mothers. Columbus, Ohio, Ross Laboratories Publications Both and Babies. New Brunswick, N.J., Johnson & Johnson Publications Phenomena of Early Development. Columbus, Ohio, Ross Laboratories Publications
Ms. Stein is Head Nurse in the Deparmient of Obstetrics and Gynecology of a community hospital in northwest Missouri. She serves as a &st lecturer on obstetrics at Northwest Missouri State University in addition to teaching prenatal classes. She holds a BSN from the University of Iowa and is a Member of NAACOG.
Septernber/October 1973 JOGN Nursing