I am thankful I work in an institution that is a Lamaze approved site. Our 
instructors are all Lamaze certified and our class content is based on the 
six care practices of Lamaze, 
http://www.lamaze.org/institute/carepractices/intro.asp.  These care 
practices were designed to promote a natural/normal birth.  FYI: the sixth 
care practice is, No separation of mother and baby with unlimited 
opportunities to breastfeed.

We have always promoted evidenced based education in our childbirth 
preparation classes, yet our cesarean rate is comparable to the national 
rate (sometimes higher).  This is frustrating and we have had many 
discussions exploring reasons for why things are the way they are.

We do not water-down any content, sticking to evidenced based teaching as 
the expected standard.  I goal is EMPOWERMENT.  Families leave class 
excited and enlightened, but something happens when they walk through the 
hospital doors to deliver.  Vulnerability and apprehension set in.  
Despite the excellent preparation, their confidence falters.

The system is broken.  The culture and the environment within the hospital 
delivery room is not supportive. Manipulation and control become the 
guiding forces.  We have explored ways to prepare parents for this, but 
even the most assertive are vulnerable.

We have tried to change culture, inviting all new nurses to sit in on a 
complete Lamaze series.  They leave excited and enlightened---yet they too 
fall prey to culture.

So we keep plugging along, making one small difference at a time.  

Casi Leahy
RN, LCCE, IBCLC

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