"How Do You Cater the EBB® Childbirth Class to AMA/IVF Couples?
©️Jennifer Anderson Birth Photography 2022
This is a question I get all the time. Is my class for everyone? Yep! It sure is! I don’t leave a thing out. But because a large part of my demographic leans towards Advanced Maternal Age/IVF couples, I love to add MORE!
I was AMA for both of my pregnancies. I am also an RN and professional doula. As an RN, I understand that there is a place for medicine in childbirth. As a doula, I also understand that not every birth requires every intervention.
Despite being AMA for my two births, I conceived both pregnancies without the aid of IVF. Yet, after 11+ years of teaching and doula work, I began to see a trend. The letters after my name also attracted a core demographic of IVF couples who have been through A LOT to get here. I know this because you always say it. "We are high-risk, and we really appreciate that you're an RN as well as a doula".
I have learned a lot from this demographic because you found me first. I didn’t know my knowledge and skills were useful to IVF couples until you kept showing up in my classes and on my doula doorstep. YOU were the one who helped me realize I have something to offer to IVF couples. A light finally went off and yes, “I see you”.
IVF couples are often AMA too because it took so long to get here. An IVF parent (of any age) and an AMA parent (who conceived naturally) have very similar values, hopes and fears about birth. Put both labels on a couple and the fear-based language can be even more overwhelming. Providers love to remind you that you're "high-risk" at every turn.
If you are pregnant and over the age of 35 and/or pregnant by IVF, I have a childbirth class for you. I see you. You’re researchers. You know more about conceiving, pregnancy, and birth than most couples do. You have achieved a great deal in your lives, and you know what you want and don't want. You don’t want a provider to patronize, placate, or push you into interventions that don’t match your values.
©️Jennifer Anderson Birth Photography 2022
But how do we know when these perceived risks turn into actual risks? How do I advocate for myself when my provider keeps using fear-based language that scares the s**t out of me? This punchy, east-coast girl has got you covered.
The Evidence Based Birth® Childbirth Class covers everything from your prenatal visits through the postpartum period. Its special sauce is two-fold:
We focus on the evidence as a '“jumping-off point” for informed decision-making in birth. If we don’t know what the research supports, then a provider's recommendation may be serving their goals and not ours. If we don't know what the recommended guidelines state, then how can we know if our provider is following them? The EBB® Childbirth Class is a thinking-person's class. You're smart and I know you have the ability and desire to comprehend birth on a deeper level.
We focus on advocacy skills to help you use your voice in powerful, yet respectful ways, so you’re heard in your birth. Your voice is the only voice that matters, and I make damned sure you have it. What good is the evidence if we don't know how to advocate for it?
I spent my entire morning in a VBAC (vaginal birth after cesarean) Facebook group reading answers to a post someone wrote asking, “Why did you have your first cesarean birth?” I’m not exaggerating when I say that about 75% of these stories were BUNK!
I'm not saying that the women are lying. HELL NO! They’re processing and healing. They're leaning into a story that they believe justified their cesarean birth. And there isn’t a lick of evidence to support many of these stories. They didn’t know that at the time, and when they learn it after the birth, the guilt and regret is real. "Had I known then what I know now, I never would have consented to my cesarean birth".
©️Jennifer Anderson Birth Photography 2022
I’ll never correct a "healing" story someone shares about their birth. We process trauma by talking story. Unfortunately, scores of pregnant couples are reading these stories and thinking “Gosh I hope that doesn’t happen to me”. We hear these stories and assimilate them as fact. We ask family and friends and Google questions about birth. Show of hands—who has gone to Dr. Google for answers? None of these places are where the facts and your values lie.
We read or hear these stories, and we assume these are valid reasons for an intervention. We assume our providers are following the evidence to help us avoid the poor outcomes we read online. Unfortunately, in many instances, providers are the ones causing these poor outcomes. There is a reason why the US ranks at the bottom of developed countries in maternal morbidity and mortality rates. It's not because we're less healthy than other countires. It's because couples are not receiving evidence-based care in childbirth. Hard stop. Plain and simple.
Case in point. The national average for episiotomies was 17% in 2018. An episiotomy is a cut between the vagina and rectum, performed while pushing, to hasten the birth. Did you know that this intervention does not improve outcomes? Did the provider tell these women that an episiotomy increases the rates of severe tears? Did that provider even ask before cutting? The recovery from episiotomies is very painful and can be long-lasting. When we question why it was performed, the provider patronizes us. "Did you want your baby to die instead? I gave you the 'husband stitch' and you have a healthy baby. What more did you want?" Did anyone shiver when you read that? I shivered writing it, but they pat you on the head and send you away time and again. Wounded and lost, wondering when you lost control.
Second case in point. An IVF mom stated in her IVF Facebook group that her birth ended in a cesarean birth because the baby swallowed too much amniotic fluid. In the words of my teen children, "Huma, huma, what, what?". It's stories like that where I'm glad I'm reading this online. If someone said this to my face, I'm not sure what noise would come out of my mouth. I'd hate to make her feel embarrassed but alas, she's retelling a story that doesn't make a lick of sense.
I refuse to stand by and let these stories take flight. I’ve made it my mission to invite as many AMA/IVF couples into my world of education and support as I can. I can't be a doula to all of you, but I sure as hell can educate every single one of you. After being an RN for 30+ years and a doula for 11+, I have the skills to make this content interesting, relatable, and palatable. Dare I say, I also make it fun.
So, let me answer the first question in this article because that’s why you're here. How do I infuse crucial material for AMA/IVF couples into my Evidence Based Birth® Childbirth Class? Well, there are a few ways:
©️Jennifer Anderson Birth Photography 2022
We explore your unique values - before making decisions in birth, we have to consider our values. What is that little person on your shoulder telling you? We should listen to that voice. Our values are the lens through which we also process our birth experiences. The EBB® Childbirth Class was build around our values. That focus on your values is what makes every single one of you unique. It is why two people will look at the same piece of evidence and come to two different conclusions - and they BOTH would be right. The EBB® Childbirth Class has no bias for this very reason.
The ARRIVE Trial - We spend a great deal of time reviewing and discussing this trial in class. This trial looked at whether we can reduce the stillbirth and cesarean birth rate by inducing labor at 39 weeks. When this trail was published in 2019, we started seeing a drastic rise in induction rates. Few AMA/IVF couples get through their pregnancy without their provider recommending a 39 week induction due to them being “high-risk”. After taking my class, couples know what this trial found as well as what it DIDN’T find. I help them apply this trial to their values as well as the care they are receiving. This knowledge helps them have informed discussions in their prenatal visits. This subject will come up if your AMA/IVF. Bet the house on it.
Inductions - The EBB® Childbirth Class covers inductions very well but I go further. We do a deep dive into inductions in our live Zoom on this topic. You learn from my years of experience as an RN and doula in how to navigate inductions with agency as well as to decide if an induction is the path you want to take. To be AMA/IVF is to hear the word “Induction” many times in your pregnancy. However, “induction” is way easier to say than it is to execute. It's more than a simple word when you're in it. Understanding what inductions entail help you weight your options from a place of knowledge and not blind trust.
Postpartum hemorrhages - You'll watch videos on this topic in the EBB® class. I bring this evidence to our live Zoom because it's rarely discussed in our prenatal visits. I strive to expand your knowledge base on this topic because it's a leading cause of maternal morbidity and mortality. I recently had this event happen to one of my doula clients. To say I’m still processing is an understatement. They are terrifying and can lead to birth trauma in either parent. Knowing what to expect, and how to minimize your risks, can make the recovery from such an event more attainable.
Hypertensive Disorders in Pregnancy (HDP) - These are a complex of diagnoses that are more common in older birthing populations. As an RN, I have a great deal of knowledge on this topic because it's common in my demographic. It often plays a role in why interventions are recommended in AMA/IVF couples. While I don't cover this disease in class, I offer private 1:1 meetings with couples grappling with this diagnosis. I encourage my clients to use me as a mentor in their journey if HDP rears its head in pregnancy. Are you taking baby Aspirin? Then your provider thinks you’re at risk for one of these diseases. Know the facts!
©️Jennifer Anderson Birth Photography 2022
If there is one comment I hear time and again, It's that my class couples felt prepared for “all the things”. Birth was less scary because they knew how to navigate these crucial conversations. They knew what to expect and how to use their voice to advocate for their choices. The only outcome I measure is satisfaction with your birth experience. If you can say “I did that” on the other side, and own every decision, then I've done my job well.
There are many EBB® Childbirth Class offerings available on my website. All classes are online with a weekly, LIVE Zoom meeting to discuss the topics reviewed that week. Take classes from anywhere.
I have couples from all over CA, WA, and OR in my classes, but if you’re in another time zone, don’t let that stop you. It didn’t stop folks from Boston, Mobile, Duluth, Las Vegas, Austin, and Boulder from joining us. The evidence doesn’t know any state boundaries. Just sayin' 🤷🏼♀️.
If you have an AMA/IVF diagnosis, then you’ll find your tribe here. And if you don't have these labels, there is nothing I mentioned above that doesn’t apply to you! AMA/IVF couples do not corner the market on inductions, hemorrhages, or HDP diagnoses. AMA/IVF couples aren't the only ones with providers who use flawed evidence in their care. EVERYONE is welcome here.
If you are over the age of 35 or pregnant by IVF, I'm saving a seat for you. I can promise you won’t be looking at your birth options in the same way when we’re done. #NoSurprises
If you're still on the fence, I have one more offer that may help you jump. On April 27, 2022, I will be featured on the Evidence Based Birth® Podcast with my muse, Rebecca Dekker, RN, PhD, and founder of EBB®. We did a deep dive on this very topic and I'm excited to share when it drops. Stay tuned!