A new style of teaching

Well, as if I haven't already transformed my life enough this year, I have had another big change. This time with my teaching. I teach antenatal classes for those that didn't know. It's my profession and obsession and the best job in the world.

Recently I had been hearing rumblings of a different approach, called "Concept Bases Courses" or CBC. A friend of mine was doing it and I went along and watched. I couldn't see a huge difference in the approach but something was different because the group were responding very differently. I booked myself onto a study day.

That was in November and was the catalyst for my knitting renaissance as the tutor taking the study day suggested that we bring some knitting. I can't thank her enough for that, but there was more to come. I'll try and explain the CBC concept, or how I see it:

Most antenatal classes are currently centred around giving information - on the stages of labour, interventions, risks, benefits etc. This is the model I have been working to since I started teaching 5 years ago. Recent research has shown that those who go to antenatal classes are not making different choices to those that don't go - the informed choice we are trying to give them is not changing their experience of childbirth. Some more research has shown something more alarming: that we are making the experience more stressful for the people in the group who prefer not to have all the information beforehand. The research calls these people 'blunters' and suggests that they are less satisfied with their experiences in labour if they have been given more information than they wanted at antenatal classes.

So, what is the solution? Lots of people do want information and you can't fail to give them what they probably came for. Alex Smith has been pioneering a new approach for which she has coined the expression CBC. This is based on a lot of theories, the blunters research is just one. Another is Neuro-Linguistic Programming (NLP) which suggests that the words we use to say something have a lot more significance than we might think. For example, the CBC approach would favour phrases like "dealing with intense physical sensations" rather than "pain relief". To some this might seem to be just a matter of semantics, or worse, giving unrealistic expecatations to clients. This is one of the reasons that CBC is contraversial at the moment.

Personally, I feel that people already know that labour is considered to be painful in our culture, and don't need an antenatal teacher saying the word all the time. After all, if we talk about pain, see pain written down, think about how to relieve the pain and cope with the pain, what are we focussing on, expecting and possibly bringing about? PAIN. If we focus on intense sensations we are already expecting to be able to handle them. This opens the client mentally to means of coping - massage, breathing, positions, mobility, water, support etc. But is this enough? In reality most first-time mothers use more than that so are we setting them up for failure? I don't think so.

I think that colluding with the rest of society in making women expect intense pain is setting them up for failure. A client recently told me that she didn't have choices in labour. After her induction and failed epidural, the doctor told her that she needed to have a caesarean and it had to be under general anaesthetic. My course had not shown her that it was her choice to book for a hospital birth, to accept an induction, to opt for an epidural, long before the caesarean was offered. Who can say how much each of these decisions contributed to the eventual situation where she didn't have a choice, but I think it is clear that she made choices. So what did my class do for her? Gave her enough information to feel informed when agreeing to interventions? Was that my intention? How are my classes serving my clients? Giving them what they wanted, or giving them what will actually benefit them? Whose place is it to decide what the clients need?

All of this is so complex and variable that I could talk myself round in circles but at the end of the day, my classes are not helping people to achieve a normal birth, which we all know is the best possible start for a new family. So, I changed.

It happened quite quickly. I don't remember making the decision to teach my first CBC - I just noticed one day that I was doing it. (A bit like pushing in second stage!) I hadn't observed a CBC or talked about planning one in the study day, so I was unfettered by other people's ideas. It was just me and the concept, and what came out of it was great. My first class was scary - I almost lost my nerve the night before. How was it different? I had no projected durations for the activities, no firm idea of how many of them I would get through, I had all new teaching aids and activities, I wasn't using the things I had used regularly for months or years, I didn't give the information I usually do, I used different terms. Basically, everything was different and it was very unsettling.

But that first class was magic. I was sat there at one stage looking at the group. One group of 4 were sat on the floor around a piece of flip paper drawing with charcoal and pastels, another group of 2 women were sat at a table making a list together on A4 lined paper and the rest of the group were sat on chairs around a piece of flip paper where one of them was making a list. They had all chosen to do it their own way, something I have been trying to encourage for years. One of the men was holding a massage ball later and said that he hadn't even thought about any of this stuff (massage, touch etc.) and I said I was glad he came. He looked me in the eye and said "So am I, I genuinely am". This was 2 hours into the course.

I was worried that because there wasn't so much information, the men wouldn't be as keen to book a day off work to attend so I was delighted when all of the men came to at least one session and one of the men told me he was so impressed after the first class that he had rearranged things at work to make sure he could attend all the classes.

Then came the second class. This one took me totally by surprise. The group had mostly opted for the low-information sessions in the first week which vindicated my new approach. On the second class they all decided they wanted information and lots of it. They wanted to know all the risks of caesarean section, for example. I gave them the information, but they didn't want to know much about assisted birth and hardly anything about induction. Was this unconcious incompetence - they didn't know what they didn't know - or just them asking for what they wanted?

One of the reasons that the CBC approach is contraversial is that it is believed to be about not covering interventions. The knee-jerk reaction to this, which I had myself, is negative and I understand that. But that is not what CBC is about. If the group want to talk about interventions, then we talk about interventions. Alex speaks of giving the "homeopathic dose of information" - a snippet that will either satisfy or prompt further investigation. Those for whom the snippet is sufficient are happy with the response. Those who want more have avenues to get it, either in 1-2-1 time with the teacher or through e-mails or handouts. No-one is left wanting information, but no-one is given more than they wanted.

After getting halfway through this first CBC I started an evening course that I intended to be more like the old-style but I found on the first night that I couldn't do it! The group read a pack of quotes from women about contractions and the first 3 compared contractions to period pains. I have used these quotes for years and never realised that to spend so much time talking about pain is not helping them at all, it's just focusing them on the negatice aspects of labour rather than what they can do for themselves. I won't be using those quotes again. I found different ways of doing what I had planned and got through. The second class was more CBC and the remainder of the course is likely to be less and less information-based.

When it came to the second half of the daytime course, which I use for the postnatal activities, there wasn't much to change. I already use activities which promote the clients' belief in themselves as experts on their baby. I tweaked some things, though, and added in some new stuff. I had the same absence of time projections and moved through activities as seemed appropriate at the pace dictated by the group. It felt lovely and the clients enjoyed it.

I don't think I will be looking back, but where does this sit with my assessing career? I will be assessing teachers doing Topic Based Courses and those doing CBC and can I keep my feelings about information overload in check? I know the answer to that, but it is an issue. The movement toward CBC is gaining momentum, particularly among students. Maybe I am going to be in demand as an assessor who understands the CBC appproach. I hope so!

This was a long blog entry, and one that has been brewing for a while. I would welcome comments from the teachers who read this. Comments about the blog, about the approach, about the way I have done it, about your thoughts and plans.

Mel