CAPPA Position on childbirth

Positive Mental Attitudes

CAPPA members believe in projecting ourselves with passion in our hearts for the work we do, confidence, a peaceful presence, positive attitudes, and good intentions.

CAPPA knows that attitude and its projection, whether positive, negative or indifferent, affects every aspect of the human life. This includes pregnancy, birth and labor, the postpartum period, breastfeeding, and parenting. CAPPA believes that a positive mental attitude is essential to the childbirth professional and serves as a strong foundation on which all other life experiences are built.

Positive mental attitude, or PMA, is a term which describes a mental attitude in which the central idea involves increasing achievement through optimistic thought processes. According to Wikipedia: "PMA implies that one has a vision of good natured change in one's mind; it employs a state of mind that continues to seek, find and execute ways to find a desirable outcome, regardless of the circumstances. It rejects negativity, defeatism and hopelessness. Part of the process of achieving PMA employs motivating "self talk" and deliberate goal-directed thinking."

CAPPA is an organization where members, volunteers, faculty, and leaders can enjoy an environment of encouragement, optimism and an expectation of success.

We believe that pregnancy, labor and birth, the postpartum period, breastfeeding, and parenting are all better experiences when an attitude of optimism and an expectation of success are present.

Methods of Childbirth & Pain Relief

In most situations and for most people, natural childbirth is the safest way to have a baby. Women should be encouraged to trust their bodies in the birth process and myths about natural childbirth should be dispelled. They should be given the tools to achieve a natural birth, if that is what they desire, and should be equipped with knowledge to make informed decisions about their birth. This knowledge should include a full understanding of the risks of interventions and medications as well as their benefits in certain situations. Education should not involve guilt but should empower women to chose the kind of birth that is best for them, be it medicated or unmedicated, intervention-free or full of traditional interventions. We believe that, given the facts, more women would choose a natural birth for themselves and their babies.

Interventions

We believe that women have the right to a birth free of unnecessary interventions. We have the duty and opportunity to educate women about the potential dangers unnecessary interventions can cause as well as the "snowball effect" they can have. We should teach the importance of true informed consent and how to achieve it using the "seven informed consent questions". No woman should feel that she does not have the right to ask any health-care provider questions about a procedure or treatment being offered or given to her. It is her right to reject any treatment or procedure that does not directly jeopardize the health of her baby. It is our job as childbirth professionals to help parents understand this right and enable them to take control of their own bodies.

Parental Responsibility

Parental responsibility begins during pregnancy. Parents have the responsibility to choose the birth place, attendant, procedures, etc. that are safest for their baby. This is not the responsibility of the doctor, midwife, doula, CBE, or anyone but the parents. While parents should be able to trust those they have chosen to assist and care for them during pregnancy and birth, none of them will have the responsibility of taking that child home and raising it. Parents should feel good about and be a part of every decision made about their care throughout the entire process of pregnancy, birth and the postpartum period as well as throughout the child's life.

Antepartum Doula Support

The antepartum doula can provide support specialized for pregnancy. This doula is extensively trained to assist mothers experiencing a high-risk pregnancy. CAPPA believes that knowledgeable antepartum doulas working along with the health-care professionals can provide care and support for healthier outcomes.

Labor Support

Women should be surrounded by those they love and trust during labor, delivery and the postpartum period. A woman's emotional support team is as vital to her birth experience as the medical team. Labor is not a time when women are able to be the lone decision-makers. Advocates who are there for her are necessary to help protect her memory of her birthing experience. Childbirth education should include information on doulas. Families should be given the tools to help the laboring woman achieve the birth that is the safest and most satisfying for her. Research has shown that most women accompanied by a doula during birth have better outcomes and are more satisfied with their birth experience.

Communication with the Health-care Team

Childbirth educators and doulas should teach families that they can negotiate their way through the waters of childbirth choices without making enemies of their health-care providers. They should also be taught how to be aware if their health-care providers or birth place will really support their birthing desires. There is a point in most births where the health-care providers must be trusted to make vital decisions and parents need to know that they are placing their trust in someone who has the same philosophy as they do. Childbirth educators and doulas have the responsibility to help parents develop their own birthing philosophy based on fact and help them prepare for the birth they want. It is not our place as educators to mold parents into our birthing philosophy, but to give them the education necessary to build a sound philosophy of their own. We can help them determine what type of birth they want, then educate them on how to achieve that birth under normal circumstances.

Techniques That Really Work

Families need to be taught that although labor is painful, there are ways to deal with this pain aside from medications. We generally encourage deep, abdominal breathing during labor. Many agree that patterned breathing techniques are not as effective as once believed. They often lead to hyperventilation, frustration on the part of the woman doing them and confusion. In some situations, however, women use them effectively and we feel they are definitely worthy of being somewhere in the laboring woman's bag of tricks. If a woman wants a natural birth, it is our responsibility to give her many techniques and help her practice them, so that when the time comes, if one thing fails she can easily try something else. Primarily, relaxation is vital if a woman is to achieve a natural birth. Coaches should be taught to recognize relaxation versus tension and how to bring the mother into a relaxed state with an emphasis on calm breathing. Women should also be taught that there is no shame in vocalization throughout birth and that this is something that many women find useful. There are benefits to changing positions, frequent urination, walking, hydrotherapy, rocking and sitting on the toilet. Different positions for pushing should be addressed. The philosophy of childbirth educators and doulas should be that "anything goes" when it comes to getting through labor as long at it is safe for the mother and baby and it is helpful to her. There is no "right way" to breathe, labor or give birth.

Feeding & Parenting

Research firmly supports that breastfeeding is the expectation of the infant and natural conclusion of the birthing process. Breastfeeding is both natural and normal. CAPPA and its approved educators and trainers will both strongly support breastfeeding and provide families with the information they need. Most mothers, when informed, will choose to breastfeed. Fathers, partners, and other helpers are an integral part of supporting the breastfeeding relationship, and should be honored as such.

CAPPA supports the WHO-UNICEF Baby-Friendly Initiative, the WHO International Code of Marketing of Breastmilk Substitutes, and the CIMS Mother-Friendly Initiative.

Parents should also be encouraged to attend a breastfeeding support group or infant feeding class while they are pregnant so that they make informed decisions about parenting and feeding methods.

We must recognize that there are reasons why some do not wish to breastfeed or cannot do so. It is our place to foster respect surrounding feeding and parenting methods, and to educate families to make truly informed decisions regarding the health of mothers and their children.

Homebirth

Women have the right to choose where they give birth, whether at home, at a birthing center or in the hospital, and we should uphold their right to do so. Every place of birth has its own risks and benefits and we should not discourage a mother from birthing wherever and with whomever she feels safest. We do, however, feel that birth should be attended by a knowledgeable birth attendant, and we will not encourage unattended or "Zion" birth.

The Postpartum Period

The postpartum period is a wonderful but difficult time for most families. Families need to be taught during their childbirth education class realistic expectations of this time so that they can plan and be prepared for it. Parents also need to be given resources to obtain help if they need it.

Postpartum Doula Support

The postpartum professional or doula is an important part of the childbirth team and the benefits of postpartum care should be promoted within the childbirth education classes. CAPPA also believes that quality postpartum doula trainings and certification should be made available