Should I bother taking a childbirth class?
This was a question recently posted on a Facebook group of mothers who are hoping to birth naturally. The consensus of mothers who responded was essentially, “Nah! You can learn everything you need from books and online.” There seems to be many variations of this question lately, so perhaps it’s time to address it in a thoughtful manner. What I am about to explain is really important, because an independent childbirth class is one of the best investments you can make in creating the safest birth possible. Yet I see mothers looking for free on-line resources because their hospital class is too expensive at $45, or $60 or whatever the local going rate is. I am fully supportive of mothers educating themselves anyway they can. I am an admitted bibliophile. I have a lending library of my favorite pregnancy, birthing and breastfeeding books, including one I wrote (available in paperback and eBook) that I hope everyone will read: Mother’s Intention: How Belief Shapes Birth. I also frequently scour the internet for the latest information. I can tell you, with 23 years as a childbirth professional, there is a plethora of misinformation out there. The problem is, you don’t know what you don’t know. If you are a first time mom (or an experienced mom who has only seen conventional hospital birth) seeking out information based on the most prevalent cultural biases, you will find a lot of bad information that will not get you a natural birth if that is what you seek. This is not judgment. This is a factual statement backed up by evidence. About 4 million women give birth each year. About ¼ of those will take a childbirth class at tall. Most of those will take the cheapest class with the least amount of time investment involved. How’s this working for women? Surgical birth rates are now more than double what the WHO has stated is optimal to save lives: Almost 33%. Induction rates are out of control leading to increases in iatrogenic (doctor causes) prematurity. Daily, the Improving Birth #BreaktheSilence campaign shares heart-wrenching stories of women who went into their births thinking they just had to show up, or thought they had informed themselves adequately, but found they were woefully ill-equipped to deal with coercion, manipulation and misinformation. The website, My OB Said What?!? shares story after story of women who are treated badly in birth by doctors and midwives who seemed really nice. Women come to my classes for second, third or fourth babies, wounded by their previous birth because they believed all they had to do was trust the ‘professionals.’ Thus, I say kudos for even looking for information. Some women just don’t bother. One woman recently wrote in The cult of natural childbirth has gone too far, “When my doctor asked me what my birthing plan was I told her I was looking at it.” Having put all her eggs in this one basket, when she went into labor during Hurricane Sandy, her (non) ‘plan’ was shot. Her labor, “…wasn't pleasant or "natural,"" unsurprisingly. Her take-away from this experience was that anyone who would want to birth naturally must be of the ‘cult’ of natural childbirth….as if there are not legitimate psychological, physiological, anthropological, sociological or philosophical reasons for desiring a natural birth. My take-away was that every woman should have to take a childbirth education class as soon as she starts menstruating. She should not only know precisely how the female body functions and how birth works, but how to give birth (as opposed to ‘being delivered'). Because here’s the thing: epidurals sometimes don’t work; epidurals sometimes are contraindicated; weather happens, natural disasters happen, man-made chaos happens, cars break down, traffic jams happen, precipitous births happen. There are so many reasons you may be alone without assistance to birth your baby. If you do not know what your body/baby are doing, the fear/tension/pain/ cycle is initiated and the whole process is likely to be miserable. It doesn’t have to be. Not to mention that the sentiment of, 'No, I didn't take a childbirth class, that's why I hired my midwife/physician/doula for' is intrinsically flawed. A midwife or physician isn't there to educate you in most cases. They will tell you to take a class for that. They do not have the 12+ hours it takes in addition to monitoring the health and wellness of you and your baby which is their job, to educate you on options, informed consent, anatomy, physiology and biology, or patient rights. Hiring a doula does not absolve you from those responsibilities either. They are there to provide emotional support and in some cases act as a consumer advocate, but even then, in the throes of labor it is not their job to try to educate you, from the ground up, on what options are available to you and why. Nor is it their job to run interference for you with a caregiver with a diametrically opposed birthing paradigm or to be in an adversarial position or environment. The purpose of a childbirth class is to make sure you have laid all of the groundwork for an optimal birth experience beforehand, and to make sure you have some small grasp on how you might navigate challenges and road blocks knowledgable and without regret. THAT is why budgeting for an independent childbirth class is important. In the last six months or so, I have gotten five inquires regarding my HypnoBirthing® classes. Two of those inquiries asked me to shorten the class series because they figured if they didn’t take as many classes, I would charge less. (I will explain in a moment why that is not possible.) Both of these were expectant mothers in professions requiring an advanced degree from two-income households. I fully realize that perhaps that doesn't mean anything regarding financial security. I do not know anyone's story. However, neither do people know mine when they make such a request. And it's complicated. I don't judge anyone for how they must place their priorities and I don't hold it against anyone trying to budget. There are currently things I deem very important that I cannot financially contribute to financially. I get it. I'm just saying that sometimes people making these requests actually are quite a bit more financially secure than I am, so they likewise shouldn't hold it against me when I can only do so much to help them. One inquiry also wanted to reduce the class length (because she was due soon) and because of that felt the price should be reduced. Since she was some distance from me, I offered to conduct the full series via Skype. Because I would not have to pay for a venue, account for travel time, mileage or gas, I offered this class at a price $90 less than my $250 class fee. I felt that was pretty generous. Two other inquiries were requests for military discounts, which I happily provided. Even though I offered to do whatever I could to make sure that anyone who wanted to take a HypnoBirthing class could take one regardless of their financial situation…short of the class actually costing ME money…only the two military moms ended up taking class with me. (They had BEATUFIFUL births, BTW.) Two of these women actually wanted detailed information on how I came up with my class fee. I find that odd. When someone hires any other professional, do they request a detailed account of just how the professional arrived at their fee? I have never hired a plumber, contractor, electrician, doctor, dentist or physical therapist and asked them first to itemize their hourly fee in justification. I think that the reason this happens to childbirth educators is because many hospitals offer very inexpensive classes. Often these classes are not only (comparatively) inexpensive, but require just a time investment of a few hours on the part of the parents. The reason for this is that is two-fold. I know this as I have taught in two different hospitals. 1. Hospital-based childbirth classes are subsidized by pharmaceutical companies, diaper and assorted manufacturers of baby paraphernalia. They underwrite the expense of the class in exchange for the opportunity to market directly to you. This includes being provided a mailing list with your name on it so that they may market to you in perpetuity. Your class materials are made and provided by people who want to sell you stuff. That's why your email and mail box start filling up with advertisements and coupons. Your name has been sold to an untold amount of manufacturers. I work ONLY for YOU. The hospital, then, has little overhead for these classes. They have the salary of the nurse teaching the class, which is likely at least $30 per hour. The venue is an existing part of their facility, purposefully. Over the years, I have been informed by three different OB nurse-managers that the birthing facility at any hospital is their best marketing tool. If they can get you to birth at their hospital, you will bring future broken arms, heart attacks and illnesses to their doors. Thus, it is very important that you be really comfortable being within their walls. 2. The material you will be offered is representative of what you will be offered at their facility, not the myriad of options actually available to you. Think about it: If you are not able to eat or drink while in labor at their facility they are going to tell you that you are not allowed to eat or drink in labor. They are not going to add that the birthing center down the street does allow that. They are not going to tell you the many ways to turn a breech if one of the two doctors at that facility automatically schedules surgery for breech. They are not going to tell you the risks of an induction if that hospital has a 70% induction rate because two of the three doctors at that facility routinely induce at 39 weeks. (Yes, these are real examples.) Not only that, but at $30 an hour, if you had a skilled professional who could be saving lives wouldn’t you prefer to limit the amount of time that person was in a classroom with a handful of people telling them how to be good patients? In stark contrast, I have to provide the class in the format in which it is offered. I signed an ethics agreement with the HypnoBirthing Institute, and the syllabus is 5 classes, each 2.5 hours, 1 week apart. I am allowed to offer a ‘plus’ addendum for mothers who want some postpartum/early parenting instruction, but I may not offer it as part of the series. In rare instances I may conduct the 12.5 hours of instruction in truncated form. For instance, if someone doesn’t find me until the last month of their pregnancy, or a partner works a swing shift and the only time the two parents are available at the same time is on the weekend, I may offer longer weekend classes and do it in a week or two of weekends, etc. but I must provide ALL of the material in 12 hours +/-. This is for the protection of the parents. There is really nothing in the 5 weeks of instruction that can be left out while still providing the same level of education & experience. If someone is telling you they can provide it in less, they are in violation of their ethics agreement which should make you question what they are leaving out. This class isn't like most childbirth classes. I've had doctors and nurses take the classes and say they learned quite a bit! Likewise, just reading the HypnoBirthing book will not teach you what you need to know. HypnoBirthing is not just teaching the technique of hypnosis and voilà! Easy birth. It’s about releasing fear, the interaction of other parents, the expertise of the educator, practicum of many hypnosis techniques, and the facilitation of effective communication techniques with care providers so that you are more likely to be able to CREATE the birth you seek. It’s not luck. I’ve had people take my class after figuring they could just buy the book or take another hypnosis for birth mail order class that was cheaper, and then find that they could not reach the level of confidence they felt they needed for it to work for them. Birth isn't a cerebral activity. That being said, The HypnoBirthing Institute does not regulate how much I charge. I currently charge less than others in the area, and less than the HypnoBirthing fee average across the board, but I’m also totally willing to exchange energy. I am of the opinion that if a woman really wants this experience, she should have it. I’ll work with parents, if I can. As long as I don’t end up subsidizing someone’s birth by putting more time and energy into it than they do, and it doesn’t /cost/ me to teach, I’m game. In order for this to not be my expensive hobby I must allow for: Teaching Time. People may assume that this is just the 12.5 hours I am in front of them speaking. Sadly, this isn’t even close. For every hour I am actually in class, I have about an equal number of hours preparing out of class. Sometimes more. This might include (but is not limited to): Responding to email questions from clients, printing handouts, researching the latest evidence-based care in childbirth education, etc. Travel Time. Yes, I have to pay myself for my time on the road, my gas, the mileage wear and tear on my car, just like any other professional. If I’m teaching from home…bonus! I don’t have to charge much for walking down my stairs and setting up my equipment. However, I still had to purchase that equipment and it does actually still take time to set up and prepare for a class. My husband is still inconvenienced in that he has to occupy himself elsewhere for a time. While I no longer have to consider this, some independent CBEs have to pay for childcare, too. If I’m traveling offsite, sometimes I drive an hour each way. That is an hour I’m not doing something else that might contribute to my household income. If I am presenting at a venue outside of my home, that usually means that at least 20% of what I make goes to the venue off the top. No matter where I conduct class, I try to provide food and drink, which is usually anywhere from $10-$20 per class, depending on the size of the class. Continuing Education. In order to remain certified through the HypnoBirthing Institute I must fulfill continuing education credits. This often requires travel to attend conferences or classes. In order to remain insured (which also costs money annually), I must be a member in good standing with the National Guild of Hypnotist, which also has a continuing education requirement apart from the HypnoBirthing CEU options. This may also require travel and/or the expense of classes or conferences. There are also dues to be a member, just like in any trade organization. Foundational Expenses. Just like any other business, I maintain a web site I must pay for, I must conduct free presentations on occasion to promote my business, which not only requires an investment of time, mileage, gas, but promotional materials such as business cards, brochures, posters, mailings, etc. Class Materials. In addition to teaching aids (movies, charts, teaching baby/uterus/pelvis, etc.) HypnoBirthing class materials include a 1/2 inch binder full of handouts I must print for each couple and the official HypnoBirthing text/CD set. This set is ONLY available in a HypnoBirthing approved class and is NOT what you purchase if you get the book from a store or online. No one pays any of these expenses for me. All of the expenses must be paid before I can even think about paying myself an hourly wage. I usually teach 4-6x per year, with anywhere from 1-6 couples in attendance. The most I’ve ever had in a class was around 12 couples, I think. I keep the classes small intentionally. There is a tremendous amount of material to cover and discussion is usually lively. If the class is too large, the couples often cannot form the relationships that lead to comfort with such intimate discussions. However, I would absolutely teach every night of the week if I could! If I did, I would happily pass the savings on to parents as much as I could while still contributing to my household income. As you can see, I do this because I love it, not because I’m getting rich. I do believe my 23 years of education and expertise should allow me to make a living, though. I’ve earned that right. I’ve seen amazing births as a result of it. I’ve seen women (and families) transformed by it, and I’ve made some really great friends along the way because of it. I’ve even been told I’m really good at it! :-) So, I will work with you in anyway I can that will meet both of our needs. Sadly, when someone decides that an independent childbirth class isn’t worth the money for their first baby, I’ll see them for a subsequent birth, but they’ll come to that class because of a hurtful first experience. This is not the place to pinch pennies. You get exactly what you pay for. After taking my class, I’ve had people in tears asking why they never learned this when they took their first, in-hospital class. I’ve also had people take both my classes and a hospital class, only to tell me they are almost teaching the hospital class because the actual instructor isn’t sharing this vital information with the other parents. Women spend months and sometimes tens of thousands of dollars to make decisions about their wedding, yet balk at what amounts to them as $20/hour for a few hours to prepare for their birth. Nurseries are planned, remodeling is done at the expense of often hundreds or thousand of dollars. We train for our jobs. Motherhood is THE most important job. The decisions you make about your birth can have lifetime of health and financial repercussions for you, your baby and your partner. Heck just avoiding an episiotomy or unnecessary first cesarean more than pays for the investment of a really great childbirth class. Like mine!
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My birth work has revolved around helping women face birth Fearlessly with a capital F.
Tokophobia is the fear of birth. This fear may be present in women who have never given birth, due to stories they've heard or cultural influences. Some of these women may choose to remain childless solely due to this fear. Some may decide to have children at some point, but will base their birthing decisions on this fear; for instance, choosing to have a surgical delivery because their fear of the process of natural birth is overwhelming. Making decisions from a place of fear, especially if the fear is based on an erroneous assumption that has become a limiting belief, means that some women might make decisions that are not in the best interest of themselves and/or their baby. The fear may manifest in expectant women who have prior bad experiences. Sadly, too many women entering the U.S. maternity care system come out disempowered, sometimes physically damaged or both, many suffering symptoms of PTSD. Over the years, many women have shared their fears with me, so I have an idea of what the most common fears are. However, I'd like to understand more completely so that I can try to help address fear where it originates. Please forward the following survey so that I can gather the most complete picture possible. Thanks. NOTES ON SURVEY: The survey is now closed. I have the data and I even had someone working on a chart representation. The data has not disappeared down the black hole that is my desktop. (Though it is circling the event horizon.) Life has intervened, but I will post it eventually. The Factual Truth About Epidurals: Are they really harmless?
by Kim Wildner The January 11, 2012 Slate.com article The Truth About Epidurals: Are they really so bad? by Melinda Wenner Moyer concludes with this paragraph: "Women shouldn’t cave to pressure from either side." [Of the 'mommy wars' between natural birth advocates and pro-epidural advocates] "They should make informed decisions based on their goals and priorities. I aspired to have a comfortable birth even if it meant being surrounded by nurses and doctors and tubes and incessant beeps; other women may trade pain for a more intimate birthing experience. Each choice comes with its own benefits and unpleasantries. My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted." I’m concerned about this piece for a number of reasons, but the most significant are summed up in this paragraph, so I’d like to start here. I agree that women should make their own best and informed decisions. I object to the continued polarization of ‘us’ and ‘them.’ I also disagree with the characterization of the options as choices between benefits and ‘unpleasantries.’ This minimizes that in consideration of birthing options we must weigh benefits and risks. This includes risks to babies as well as ourselves. Thus, while the decisions very well may be based on ‘goals and priorities’ I would argue that the highest priority must be the health and well-being of the mother-baby dyad. Reducing the choice to that of comfort vs. an 'intimate' experience ignores that many women choose natural birth not because of the 'experience' but to minimize risk. Every intervention was introduced for a valid reason and when used appropriately, has the potential make a difficult birth better. That does not mean every intervention is appropriate for every situation. When used inappropriately, every intervention has the potential to also cause problems. This includes epidurals and other labor drugs. To suggest otherwise and is disingenuous...and a huge disservice to those trying to make an informed decision. I spent hours trying to look up the studies that the author mentioned but failed to cite. I did not find her references, but she was correct in her assertion that the evidence is ‘inconclusive.’ The vast majority of studies do say that rates of surgical deliveries increase due to a multitude of reasons involving epidurals. A handful suggested otherwise. So I went to The Cochrane Collaboration, the largest independent collection of available medical studies, encapsulated in A Guide to Effective Care in Pregnancy and Childbirth. This source states, “In women with epidural analgesia, both the first and second stages of labor are longer, and oxytocin use, malrotation and cesarean sections are more frequent.” (Enkin, et al p. 291) The Cochrane Collaboration last updated in 2011 states: "The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes with epidurals would be helpful." (Anim-Somuah, Smyth & Jones, 2011) Cesarean rates did not increase overall, but risk of cesarean section for fetal distress was increased? The experience of very low blood pressure often leads to fetal distress which leads to surgical birth. If a complication can be directly attributed to the epidural, and it leads to emergency surgery, is the surgery then considered due to a medical complication instead of the epidural, even though the complication would not have occurred in the absence of the epidural? If a study does not compare natural birth to medicalized birth, how can any conclusions be drawn about how the interventions impact a birth? And does it matter if the research is possibly tainted by special interests anyway? Dr. Marcia Angell, the Editor of the New England Journal of Medicine, said in 2009: "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine." (Angell, 2009) When looking at the evidence in trying to make a decision as important as that regarding the long term health of our children, this should lead consumers to ask: Where is the funding for a coming from and who is performing it? Who loses revenue or might be out of a job if tools like epidurals are used sparingly? I hear a lot of disparaging remarks about natural birth advocates, but what do they have to gain by questioning the safety of labor drugs? Wenner Moyer suggests that we compare the objective evidence with “...the reassuring words of obstetricians and anesthesiologists who tout epidurals as being completely safe.” What makes her think that her doctor or anesthesiologist is making a recommendation on scientific evidence anyway? Reading the summary of ACOG recommendations for suspected fetal macrosomia (big baby) 2/3 of obstetrical recommendation not evidence-based! (Chatfield, 2001) A Guide to Effective Care in Pregnancy and Childbirth reveals this is hardly unusual. If we are only asking ‘Do epidurals effectively reduce or eliminate pain?’ and ‘Is there 100% consensus on safety?’ Wenner Moyer’s article addresses those questions. That is also providing that the only thing one is concerned about is whether the mother will end up with a surgery that has a 5 times greater mortality (death) rate than natural birth. But what about other consequences of epidurals? And what about just a little bit of plain old common sense. My best fell down a flight of stairs at 40 weeks, 4 days. At the hospital it was determined her baby was fine, but she had a broken tailbone. She asked for something for the pain and was told there was nothing they could give her that was safe for the baby. BUT if they would just let them induce her, she could pain relief. She asked them to just give her what they would give her in labor. If it would help then, why couldn’t it help now? They refused. She asked, ‘You can create pain with an induction and give me something for the pain you create, but you can’t give me the same drug for the pain I’m in? What kind of sense does that make?” They couldn’t answer that. She declined to be induced. If any mother were to test positive for a narcotic or cocaine, do you think there would be negative consequences? If a mother who had an epidural would have in her body a 'caine derivative, lidocaine, not approved by the FDA for use in pregnancy, labor, delivery or lactation, but used none-the-less. Or she might have narcotics like Stadol or Mepergan, also not approved for use in labor, but used often. Again, a drug is a drug is a drug and the effects are the same. It doesn’t change because it’s administered by a nurse or anesthesiologist. Stating the obvious does not mean that an epidural is never helpful or necessary. Stating the facts is not guilt inducing any more than stating that grass is green should make someone who is colorblind feel guilty because they see it as yellow or blue. The fact is grass is still green. This brings me to the notion that birth is always excruciating. If the debate is framed in such a way as to present the only choice as excruciating pain or completely safe numbness, it would seem crazy to opt for natural birth as opposed to risk-free drugs. Except that that isn’t being honest and those aren’t the only options. As a HypnoBirthing® instructor with more than 20 years experience in childbirth I expect a birth to fall somewhere on a continuum: A few ecstatic and/or orgasmic; about 30% painless without drugs; the vast majority mostly comfortable with either manageable discomfort or complete comfort throughout until the last hour or so; some that are painful, but empowering instead of insufferable; a few epidurals; a few cesareans. Some women will be upset with a 45 minute labor. Some will be perfectly happy with 3 days back labor ending in a cesarean. Interpretation of circumstance is what we make of it. Perception is reality. When women are confident that they are fully capable of making the best decisions for themselves no matter what situation is presented, because they made their decisions on the actual events specific to them and not an imagined potential reality, they do not feel a need to defend their decision. What I teach is evidenced-based and geared toward that end, but it still won’t be applicable to every child, mother or family. I advocate for natural birth and breastfeeding because of the benefits it conveys. It makes life easier, MOST OF THE TIME if we do not try to fight nature. But if it is not benefiting the mother and baby, or if the mother just does not want to avail herself to the benefits and prefers to create difficult situations, that is her prerogative. I don’t think it’s fair, to say of excruciating, dysfunctional labor, ‘this is what birth always is’ when so many difficulties are created, not encountered. Parenting comes with enough challenges without having to deal with ones that might have been avoided! One of the best ways to avoid the pitfalls is to take an independent childbirth class. Each year, 1 million out of 4 million birthing women will take a class at all. Of those that do, most will take a ‘prepared childbirth’ class offered by their hospital. I’ve taught those classes, and I can tell you they exist to make life easer for the hospital, not the parents. Think about it: If “60-80 percent of first-time pregnant American women’ get epidurals do, as Wenner Moyer suggests, then the classes are doing a pretty poor job of preparing anyone for anything other than when to get their epidural. I pass on evidence-based information for those that want it. In doing so I hope to make life easier for women, babies and families. But if the evidence-based isn’t easier, or possible, or simply not wanted, ignore it. Because ultimately, the key to ending the phenomenon we know as ‘The Mommy Wars’ is to make your own best decisions based on all the (independently verifiable) information available at the time, tempered with commonsense based on individual situations. No one else lives your life. No one else is responsible for the consequence of your actions. It doesn’t matter what you do, someone is going to think you are doing it wrong. The key to not letting that bug you is to be sure of your decisions, and know WHY you are making them. If it’s something someone else considers unsafe, like home birth in my case, make damn certain you know it IS safe, at least for your situation. That way if someone does accuse you of being a bad parent, you can actually use it as a teaching moment instead of getting your knickers in a twist. AIMS. (Alliance for the Improvement of Maternity Services): Drugs not FDA approved for obstetrics http://www.aimsusa.org/ObstetricDrugs-NotApproved.htm Angell,M., 2009. Drug Companies & Doctors: A Story of Corruption. The New York Review of Books. http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/ Anim-Somuah M, Smyth RMD, Jones L., 2011. Cochrane Supparies: Independent high-quality evidence for health care decision making. Epidurals for pain relief in labour. http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour Chatfield, J., ACOG Issues Guidelines on Fetal Macrosomia, Am Fam Physician. 2001 Jul 1;64(1):169-170. Retrieved from http://www.aafp.org/afp/2001/0701/p169.html Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., Hofmeyr, J., A Guide to Effective Care in Pregnancy and Childbirth, 3rd edition, 2000. Oxford University Press, USA. Wenner Moyer, M., 2012. The Truth About Epidurals: Are they really so bad? Posted Jan. 11, 2012, at 3:28 PM http://www.slate.com/articles/health_and_science/medical_examiner/2012/01/the_truth_about_epidurals.html Kim Wildner is the author of Mother’s Intention: How Belief Shapes Birth and creator of Fearless Birthing™, workshops designed to assist birth-workers in facilitating evidence-based decision-making in their clients. She has been published in a number of birth related trade journals and spoken internationally with her latest speaking engagement at National University Hospital in Singapore. Wildner has more than 20 years experience in childbirth education and passed the North American Registry of Midwives (NARM) exam in 1993. She has been a HypnoBirthing® Certified Educator for over 10 years and holds a BA in Organizational Communications. |
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