Pain in Labor: Making Plans.

In this column, the associate editor of The Journal of Perinatal Education introduces Henci Goer's new book, Labor Pain: What's Your Best Strategy?: Get the Data. Make a Plan. Take Charge of Your Birth. The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Advancing Physiologic Birth Through Midwifery and Community Birth.

In this column, the associate editor of The Journal of Perinatal Education discusses the importance of advancing physiologic birth through midwifery and community birth by introducing the two featured articles in this issue by Dr. Carol Sakala: Improving Midwifery Care Through Midwifery (Sakala et al., 2021) and Improving Our Maternity Care Now Through Community Birth Centers (Sakala et al., 2022). The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Celebrate Birth!-A Life's Journey.

In this column, the author describes her experience of being with a woman giving birth naturally and the profound effect this had on her life personally and professionally. The experience set the stage for her own natural births and a lifetime of advocating for safe, healthy birth.

Feature Article-The International Childbirth Initiative: Twelve Steps to Safe and Respectful MotherBaby-Family Maternity Care.

In 2019, the International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecology and Obstetrics (FIGO) released The International Childbirth Initiative (ICI): Twelve Steps to Safe and Respectful MotherBaby-Family Maternity Care. The 12 steps reflect the most recent evidence and understanding of what constitutes safe, respectful maternity care. This column presents the 12 steps and describes the process for developing the ICI.

Safe Childbirth: A Call to Action.

Since the publication of Lamaze's Six Healthy Birth Practice papers in 2014, there has been increasing concern with the safety of the current maternity care system. A doubling of the maternal mortality rate in the United States and the continued high cesarean rate, as well as ongoing research that supports physiologic birth and identifies the risks of interfering with the physiologic process, has resulted in updated guidelines for care and has spurred advocacy efforts to transform maternity care. This article presents a number of these advocacy efforts.

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary.

Maternity care in the United States continues to be intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy has decreased but is still higher than it should be. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This paper describes the use and effect of routine interventions on the physiologic process of labor and birth and identifies the unintended consequences resulting from the routine use of these interventions in labor and birth.

Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing.

The Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing charts an efficient pathway to a maternity care system that reliably enables all women and newborns to experience healthy physiologic processes around the time of birth, to the extent possible given their health needs and informed preferences. The authors are members of a multistakeholder, multidisciplinary National Advisory Council that collaborated to develop this document. This approach preventively addresses troubling trends in maternal and newborn outcomes and persistent racial and other disparities by mobilizing innate capacities for healthy childbearing processes and limiting use of consequential interventions. It provides more appropriate care to healthier, lower-risk women and newborns who often receive more specialized care, though such care may not be needed and may cause unintended harm. It also offers opportunities to improve the care, experience and outcomes of women with health challenges by fostering healthy perinatal physiologic processes whenever safely possible.

Promoting optimal care in childbirth.

In 1996, the World Health Organization set out guidelines for normal birth. Because that time birth in the United States has continued to be intervention intensive, the cesarean rate has skyrocketed and maternal mortality, although low, is rising. At the same time, research continues to provide evidence for the benefits of supporting the normal physiologic process of labor and birth and the risks of interfering with this natural process. This article reviews the current state of U.S. maternity care and discusses research and advocacy efforts that address this issue. This article describes optimal care in childbirth and introduces the Lamaze International Six Healthy Birth Practices.

Healthy birth practice #4: avoid interventions unless they are medically necessary.

Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #4: No Routine Interventions," published in The Journal of Perinatal Education, 16(3), 2007.

Knowledge and skills of the lamaze certified childbirth educator: results of a job task analysis.

Content validity of certification examinations is demonstrated over time with comprehensive job analyses conducted and analyzed by experts, with data gathered from stakeholders. In November 2011, the Lamaze International Certification Council conducted a job analysis update of the 2002 job analysis survey. This article presents the background, methodology, and findings of the job analysis. Changes in the test blueprint based on these findings are presented.

Being safe: making the decision to have a planned home birth in the United States.

Although there is evidence that supports the safety of planned home birth for healthy women, less than 1 percent of women in the United States choose to have their baby at home. An ethnographic study of the experience of planned home birth provided rich descriptions of women's experiences planning, preparing for, and having a home birth.This article describes findings related to how women make the decision to have a planned home birth. For these women, being safe emerged as central in making the decision. For them, being safe included four factors: avoiding technological birth interventions, knowing the midwife and the midwife knowing them, feeling comfortable and protected at home, and knowing that backup hospital medical care was accessible if needed.

Evidence-based maternity care: can new dogs learn old tricks?

In this article, a Lamaze Certified Childbirth Educator describes her efforts to change the culture of birth in a community hospital in a small Midwestern town. Her experience highlights the challenges and the frustrations involved in creating change. The authors reflect on ways to enhance the success of change and advocacy strategies.

Continuing education module top 10: tips on teaching lamaze classes.

Lamaze classes should help women think differently about birth, dispel myths, and ultimately make informed decisions that are right for them. In the current maternity care environment, this is a monumental task. In this column, the authors discuss 10 teaching tips that serve as a guide for teaching childbirth classes and ultimately facilitate learning.

Giving birth: "we just don't talk about it".

In this column, Alyson Grauer, a young woman recently embarking on her postuniversity career, shares her experiences with friends who do not talk about childbirth. She contrasts their fear and their unwillingness to talk and learn about birth with her own experience being the daughter of a Lamaze Certified Childbirth Educator and doula. Grauer's experiences provide a backdrop for a deeper understanding of young adults' beliefs about childbirth. Judith Lothian provides insight related to when and why women and men stopped talking about birth and the implications for childbirth education.

Risk, safety, and choice in childbirth.

In this column, the author explores current understandings of risk and safety in pregnancy and childbirth. An emphasis on risk management places the provider and hospital in control of women's decisions related to pregnancy and birth and may make pregnancy and birth less safe for mothers and babies. Accepting that no life is risk free, women can let go of fear and make choices that take into account real, not imagined, or exaggerated risk and, in doing so, increase safety for themselves and their babies. The focus of maternity care becomes enhancing safety through evidence-based practice rather than managing risk.

Making the case for a physiologic approach to childbirth.

In this column, Optimal Care in Childbirth: The Case for a Physiologic Approach by Henci Goer and Amy Romano is reviewed. The book presents compelling evidence for the value and importance of a physiological approach to childbirth and provides a clear, exhaustive guide for making sense of the research in the context of the current maternity care system. The book is an invaluable resource for navigating the maze of contemporary obstetrics for both health-care professionals and childbearing families.

Lamaze breathing: what every pregnant woman needs to know.

Lamaze breathing historically is considered the hallmark of Lamaze preparation for childbirth. This column discusses breathing in the larger context of contemporary Lamaze. Controlled breathing enhances relaxation and decreases perception of pain. It is one of many comfort strategies taught in Lamaze classes. In restricted birthing environments, breathing may be the only nonpharmacological comfort strategy available to women. Conscious breathing and relaxation, especially in combination with a wide variety of comfort strategies, can help women avoid unnecessary medical intervention and have a safe, healthy birth.

How do women who plan home birth prepare for childbirth?

In this column, the findings of a secondary analysis of data from a larger qualitative study of the experience of home birth are discussed. The aim was to describe the ways in which women who plan home birth prepare for their births. The findings provide support for the idea of birth preparation and education occurring throughout pregnancy and describe the ways in which women planning to give birth at home develop confidence, plan for support, and make decisions related to the particulars of the labor and birth. Implications of these findings for childbirth education are explored.

Safe, healthy birth: what every pregnant woman needs to know.

In spite of technology and medical science's ability to manage complex health problems, the current maternity care environment has increased risks for healthy women and their babies. It comes as a surprise to most women that standard maternity care does not reflect best scientific evidence. In this column, evidence-based maternity care practices are discussed with an emphasis on the practices that increase safety for mother and baby, and what pregnant women need to know in order to have safe, healthy births is described.