Learning Objectives
By the end of this section, you will be able to:
- Discuss the history of Lamaze International childbirth education
- Verbalize the six evidence-based healthy birth practices that encompass the Lamaze International childbirth education practices
- Summarize the importance of shared decision making within the Lamaze International childbirth education program
- Summarize the importance of understanding the process of physiologic birth when educating birthing persons and their partners
- Discuss the education that is provided to birthing persons and their families regarding the postpartum period
Becoming educated in the process of pregnancy, labor, birth, and postpartum and newborn care is called childbirth education. It is a significant nursing intervention that can improve birth outcomes and the birth experience for the entire family. Lamaze is an educational platform that families have used to improve their confidence by preparing for birth. Lamaze is taught in many different birth settings.
History of Lamaze Childbirth Education
The Lamaze method was introduced in 1951 in France by Dr. Fernand Lamaze, who developed a technique for childbirth that consisted of relaxation, childbirth education classes, continuous emotional support, breathing techniques, and specially trained nurses who helped birthing people manage the intensity of birth (Lamaze International, n.d.). In the late 1950s, the Lamaze technique started to be used in the United States. Over time, Lamaze teachings shifted from childbirth education only to an evidence-based practice that supports physiologic birth and prepares birthing people to have confidence in their ability to birth and parent.
Evidence-Based Lamaze Childbirth Education
Research shows that labor care provided by a Lamaze-informed nurse increases rates of vaginal birth, shortens lengths of labor, and reduces pain and postpartum bleeding in first-time birthing patients (Wu et al., 2021). Moreover, birthing people have increased knowledge of pregnancy, nutrition needs, and exercise needs after completing Lamaze education (Mahalakshmi et al., 2018). Research has identified no risks associated with Lamaze childbirth education. These significant benefits should be discussed with hospitals and health-care providers and should be offered to families in their pregnancy care. The drawbacks to this method for patients include lack of access to the education, cost of the education, and inability to attend the necessary 8 weeks of sessions to complete the education. These factors can be a significant barrier to improved outcomes, especially in populations at higher risk who may want these resources but be unable to obtain them.
The WHO recommends four care practices, which were built into the Lamaze philosophy:
- Let labor begin on its own.
- Continuous labor support should be provided.
- Persons should avoid giving birth lying on their back.
- Birthing person/newborn couplets should stay together.
Two additional practices, position changes and avoidance of interventions, were added later. These recommendations are echoed in many other childbirth-education models as foundational practices that improve the experience and outcomes of birthing people (Lothian & Devries, 2017).
Let Labor Begin on Its Own
Spontaneous labor occurs by multiple avenues that are explored in Chapter 15 Process of Labor and Birth. Supporting the process is crucial to reducing interventions. Labor often begins in dark, calm, comfortable environments. If the environment is disrupted, this can stall or disrupt the process. Lamaze teaching includes a preference for the baby to come on their own when ready, to have early labor undisturbed in a comfortable or familiar environment, and to avoid the risks of induction of labor except for medical indications (Lothian & Devries, 2017).
Cultural Context
Traditions and Culture Surrounding Birth
Birthing traditions are oftentimes associated with culture or religion. For example, in Cambodia and Lebanon, female relatives are in the room for birth; husbands are not in the room. However, fathers in India are more likely to be present during the birth. In Iran, pregnant persons many times attend Lamaze classes. Nurses must ask patients their preferences and respect their cultural values.
(Boules, n.d.)
Position Changes
The weeks leading to birth can prepare the body for labor. Lamaze teachings recommend that as labor nears, pregnant people should avoid semireclined positions like propped positioning in bed and reclined chairs to avoid undesirable fetal positions. Frequent position changes during labor, especially a balance of upright and restful positions, can encourage labor progression and prevent fatigue (see 17.1 Nonpharmacological Pain Management). The American College of Obstetricians and Gynecologists (ACOG; 2019) suggests frequent position changes during labor to increase comfort and assist in fetal positioning. Research has shown that labor can be shortened by more than an hour for persons laboring in an upright position (Ondeck, 2019). Freedom of movement is one of the core principles of a healthy birth (Lothian & Devries, 2017).
Continuous Labor Support
People typically deal better with stress when surrounded by people who love and respect them. Labor support goes much further than reviewing monitor strips and changing intravenous (IV) fluids. Labor support includes respecting the person’s space and providing reassurance that they are capable of birth. Quality labor support can be provided by a labor nurse offering heat or ice for comfort, assisting with position changes, providing words of encouragement, or holding space without discomfort in the silence, when words may be disruptive (Lothian & Devries, 2017). A loved one or doula can also provide excellent labor support, especially when nurses have additional responsibilities and are caring for more than one patient.
Avoid Unnecessary Interventions
Lamaze teaching cautions against the use of continuous fetal monitoring, restricted eating or drinking, intravenous fluids, epidural anesthesia, artificial rupture of membranes, induction or augmentation with oxytocin (Pitocin), or episiotomy (Lothian & Devries, 2017). These interventions are not done unless they are medically necessary. ACOG (2019) suggests individualized labor management according to pregnancy risk factors. Lamaze stresses the importance of shared decision making between the couple and health-care provider. ACOG also notes that intermittent auscultation, noncoached pushing, not artificially rupturing the membranes, and family-centered care are safe for low-risk persons and help limit interventions in labor.
Push in Your Own Position
When allowed to choose, most laboring persons prefer to push in the upright position (Huang et al., 2019). This position allows gravity to assist in the descent of the fetus. The majority of laboring persons in hospitals in the United States are placed in a supine position, which does not encourage spontaneous pushing efforts. Lamaze teaching recommends pushing how and where it feels right to the birthing person because their body and instincts know the exact movements that are necessary for the fetus to navigate the pelvis (Lothian & Devries, 2017).
Couplets Should Stay Together
Birthing people and their newborns should remain together, as shown in Figure 14.2. This idea is a constant theme throughout most childbirth-education programs and even part of the Baby-Friendly Initiative (BFI) in the United States. The BFI was developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) as a global program to implement the “Ten Steps to Successful Breastfeeding” (Baby-Friendly USA, 2024). Lamaze teachings include couplets staying together to improve their bond, assist with breast-feeding, and assist with newborn transition to extrauterine life (Lothian & Devries, 2017).
Shared Decision Making
Shared decision making improves patient autonomy, satisfaction, and safety and reduces health-care costs (Vanderlaan & Givens, n.d.). Because evidence supports shared decision making, Lamaze International has added this to its advocacy resources and recommendations for health-care providers (Vanderlaan & Givens, n.d.). Research shows that the most confounding factor for use of shared decision making is the short duration of a prenatal visit (Vanderlaan & Givens, n.d.). Childbirth education like Lamaze can fill the gap and provide time for questions and answers so that patients have the knowledge to make informed decisions and develop a written birth plan to share with their health-care provider and birthing facility.
Rights of Childbearing Persons
Knowing the rights of birthing people is crucial for nurses. Not all people are provided the same rights for birth as others. For example, Black people have been denied equal rights in birth through overt decisions and systemic racism. Lamaze points out that it is not the job of the Black person to fight for equal rights in the health-care system during labor. Instead, it is the responsibility of the nurse and health-care provider to provide care that is equal and nonbiased (Terreri, 2020). The nurse advocates for the birthing person and family, and if that advocacy is not deeply engrained in the nurse, it may not be possible for them to provide safe, equitable, and quality care. Lamaze education includes an extensive list of patient rights with which all obstetric nurses should become familiar (Terreri, 2020).
Link to Learning
Take a few moments to review the Universal Rights in Giving Birth by Lamaze International.
Communication and Negotiation Skills
Lamaze teachings include educating the pregnant person or couple on how to communicate a preference for nonintervention of the health-care provider into the labor progress and birthing process when a low-risk labor and birth are expected. The strategies taught include alertness, informed basis for decision making, confidence in the knowledge gained, and communication through requests for explanations and more information as well as available alternatives. This allows the patient and family time to weigh the risks and benefits of each option (Lothian & DeVries, 2017).
When and How to Connect with the Health-Care Provider
As previously discussed, the biggest risk for having a cesarean birth is the birth setting. Lamaze teaches families to find the environment in which the patient is most comfortable. Patients should research the type of health-care provider that mirrors their philosophy of birth, whether that is an OB, a midwife, or a family practitioner. Lamaze also teaches patients to trust their instincts and change providers if they no longer feel comfortable or sense their provider is no longer using shared decision making (Grauer, n.d.).
Physiologic Birth Process
When a birth occurs vaginally and without medical intervention, it is considered a physiologic birth (International Childbirth Education Association [ICEA], 2015). Factors that increase the success of physiologic birth are the pregnant person’s health and childbirth education (ICEA, 2015). Factors that interrupt physiologic labor are artificial rupture of membranes prior to active labor, induction of labor, augmentation of labor, and epidural anesthesia. Lamaze education identifies the normal processes of birth and the few alterations from normal that indicate the need for intervention. These teachings also include lists of basic care, screening options, and interventions categorized by their balance of risks to benefits, including effectiveness (Lothian & DeVries, 2017). Lamaze supports the American College of Nurse Midwives, Midwives Alliance of North American, and the National Association of Certified Professional Midwives’ joint statement, titled “Supporting Health and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM” (Muza, 2012). The principles taught in Lamaze give patients the opportunity to make informed choices that allow for physiologic birth to occur.
Link to Learning
Read this article that discusses the consensus statement by ACNM, MANA, and NACPM supporting normal physiologic childbirth.
Birth Is Normal
Lamaze teachings include the following six healthy practices for birthing persons that promote normal birth:
- Let labor begin on its own.
- Walk, move around, and change position throughout labor.
- Bring a loved one, friend, or doula for continuous support.
- Avoid interventions that are not medically necessary.
- Avoid giving birth on your back and follow your body’s urges to push.
- Keep birthing person and baby together; it is best for both and for chest-feeding.
(What is a safe and healthy birth? n.d.)
The Lamaze teachings also include references from the Cochrane Database of Systematic Reviews as evidence that birth is normal (Lothian & DeVries, 2017). Lamaze International attempted to define “normal birth” and found that 36 percent of polled persons assigned female at birth felt that “normal birth” meant they had had a vaginal birth; 63 percent of Lamaze instructors defined it as any birth without interventions (Prusky, 2010). No consensus exists of what constitutes a “normal birth,” but Lamaze teaches that avoiding unnecessary interventions and following evidence-based practice will lead to a successful, satisfying birth experience.
Physical and Emotional Responses to Birth
Preparing for birth includes exploring expectations about and tools needed to navigate the intensity of labor. Lamaze teachings include how to view birth as a task instead of a trial, as pain with a purpose; how to create a comfortable environment, reduce pain perception, find a rhythm in the ebb and flow of labor; and how to acknowledge the realities of labor pain (Lothian & DeVries, 2017). Patients taking Lamaze classes learn that labor is normal and that preparing emotionally with their partner is an important part of birth preparation. They are also taught exercises to prepare their body for birth; these are summarized in (Table 14.1).
| Trimester | Exercise* |
|---|---|
| Every trimester | Walking Swimming Yoga Kegels |
| First trimester | Can continue to perform the same workouts as prior to pregnancy Taking a break when needed Staying hydrated |
| Second and third trimesters | Focus on low-impact exercises Yoga Strengthening muscles for labor Taking breaks when needed Avoid lying on back during exercises |
*The pregnant person should always check with their provider before starting an exercise routine. |
|
Last Weeks of Pregnancy
Preparing for labor takes months, even though the process itself may take only hours or days. The weeks leading up to birth can be physically and emotionally taxing. Lamaze teachings review the meanings behind these late-pregnancy discomforts and how to ease through them to prepare for a positive birth (Lothian & DeVries, 2017). Lamaze teaches that many pregnant persons will have backaches, insomnia, hip pain, and discomforts of pregnancy in the third trimester. Their recommendations consist of the following:
- Remember the person will not be pregnant forever.
- Take time to sit and feel the baby inside.
- Take naps and rest.
- Take a bath.
- Stretch, do yoga.
(Terreri, 2020)
Postpartum Life and Parenting
The transition into parenthood or the addition of a new child to a previously smaller family unit is an adjustment. Lamaze teachings include information on the transition to extrauterine life for the newborn, bonding with the birthing parent, overview of newborn procedures and feeding, adjusting to life with a newborn, and postpartum recovery. Distinguishing between expected physical and emotional changes and those that can be warning signs of pathologic processes is crucial for birthing people and their nurses to understand. Lamaze teachings help identify when to seek for help when trouble arises (Lothian & DeVries, 2017).