The American College of Obstetricians and Gynecologists Childbirth Prepara- tion Program: A Program for Prac- ticing Useful Labor Techniques at Home. Produced and directed by Pris- cilla Ulene and Art Ulene, MD, 1985. Color, sound, 60 minutes. Available in %-inch VHS and Beta videocassettes from Feeling Fine Programs, Inc., 3575 Cahuenga Blvd. West, Los Angeles, CA 90068. l-800-332-3373. Purchase price: $39.95 for %-inch VHS/Beta; $9.95 LP record; $9.95 audio cassette.

Reviewed by: Linda Wheeler, CNM, EdD,

Associate Professor, Oregon Health Sciences University, Portland, OR.

With this videotape, The ACOG attempts to augment the information and mate- rials provided by physicians and child- birth educators (nurse-midwives are not mentioned) in hopes that families will spend $39.95 to have this supplement in their homes.

The tape is divided into two parts. The first 30 minutes show techniques to re- lease tension and relieve discomfort. Caucasian, black, and Hispanic women demonstrate relaxation and breathing methods alone and with partners. Dressed in white bodysuits they practice on a white bed/table against a white background with their partners/coaches clad in white jogging suits.

The second 30 minutes of the tape show 14 of the women some of whom were seen in the first segment laboring and giving birth. Babies are born in birthing rooms, delivery rooms, and operating rooms. Some women labor in

their own clothes; others are attached to electronic monitors and IVs. A small child is present at one birth while at another the mother reaches down to deliver her baby. One woman delivers on her side. Twins are born. Most of the women ap- pear to deliver without anesthesia, al- though at least one probably has an epi- dural. After the births, the participants are interviewed and a flashback from the labor preparation section of the tape is shown.

My initial reaction to the first few minutes of the tape was that it was slick, and not very relevant to a large portion of the American population having babies. The models are heavily made-up and the ambience is unrealistic. How- ever, as I listened to the narrative, I liked what was being said. Many techniques that could be used in labor are advo- cated:

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2) 3) 4)

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Relaxation (“Let the air flow in and out without resistance.“) Imagery (“Melt into the warm sand.“) Suggestion (“You are relaxed.“) Breathing (“Take slow, deep breaths.“) Touch (“Use your whole hand to give a gentle massage.“) Movement (“Get on your hands and knees.“) Encouragement (“Remind yourself that you are doing well.“) Vocalizing (“Sometimes it feels good to make noise. Do it out loud.“)

Many comfort measures (massage, ice chips, cool cloths, lip care) are demon- strated and it is fun to realize that the

Journal of Nurse-Midwifery ??Vol. 32, No. 2, March/April 1987

Copyright 0 1987 by the American College of Nurse-Midwives

women seen laboring are the same women who were the made-up models in the first segment of the tape.

Throughout the video, variety is em- phasized from the women chosen to par- ticipate to their birth scenes. The unique- ness of each woman and her labor is considered and labor is presented realis- tically. The suggestions given for coping with labor are demonstrated, not just ver- balized.

I showed the video to five childbirth educators with whom I work. Each felt that the voice of the narrator was not re- laxing and that the directions were too rapid for compliance. The pace of the practice segment is admittedly fast; but women already in a childbirth class would probably respond quickly to the instructions. Furthermore, discussion be- fore and/or after viewing the tape would provide answers to questions or concerns that might arise. One childbirth educator commented that the birth scenes were disconnected and expressed fear that lay viewers would have many questions about the use of interventive modalities (oxygen, etc.).

I asked two women confined to bed due to premature onset of contractions to see the tape. Neither had arranged for private childbirth classes. After one viewing, both agreed that the directions for relaxation and breathing did not allow adequate time for practice. They were confused when verbal briefings for breathing differed from what the model was illustrating. However, after replays clarified their confusion, both women found the tape helpful and also enjoyed the birth scenes. They appreciated the

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0091-2182/87/$03.50

realism despite some initial fright and ad- The American College of Obstetricians missions of not understanding what was and Gynecologists Postnatal Exercise happening in each birth. Yet this lack of Program. Produced and directed by knowledge apparently did not interfere Priscilla Ulene and Art Ulene, MD, 1985. with learning from what they saw. Color, sound, approximately 50 minutes.

My brief experience with women who Available in %-inch VHS and Beta vi- viewed the tape without the help of a deocassettes from Feeling Fine Pro- childbirth educator or other health care grams, Inc., 3575 Cahuenga Blvd. West, professional led me to conclude that Los Angeles, CA 90068. 1-800-332- these women may find the explanation 3373. Purchase price: $39.95 for %-inch of when to change the type and rate of VHS/Beta; $9.95, LP record; $9.95, breathing inadequate. When the models audio cassette. breathe according to the speed sug- gested by the narrator, they use specific

Reviewed by: Susan L. Hassett, CNM,

breathing techniques. Guidance in how MN, Director of Women’s Health Ser-

to use these techniques is not given, al- vices, HealthLink; Certified Pregnancy

though slow, deep breaths in early labor Fitness Instructor, Portland, OR.

and faster breathing in advanced labor The ACOG Pregnancy Exercise Program are suggested. is a technically attractive videocassette

The segment on pushing is a disap- tape of a lively choreographed fitness re- pointing part of the videotape. While gime supposedly designed for pregnant women practice pushing in semi- women. The tape is visually and sensor- Fowler’s and side-lying positions, the in- ially appealing. The background music is structions given to advance the baby soft enough to allow directions to be through the birth canal are: “Take a heard, lighting is pale but adequate, set deep breath, hold it, count, and let a little design utilizes pastel colors, and the breath out.” No mention is made of en- editing is smooth. Shots both of indi- couraging a woman to listen to her body viduals and the group of performers aid and push according to its cues. in demonstration of the exercise, and the

Overall, the tape would be an asset to performers actually look like they are at childbirth educators and their class par- ease and enjoying themselves! ticipants. However, the $39.95 videocas- An opening statement by Dr. Art sette purchase price may be prohibitively Ulene of NBC’s “Today” Show advises expensive for some people. The $9.95 previewing the entire program and com- LP record or audio cassette price may be panion booklet before accompanying the a financial alternative. Since I did not performers. I would question the compli- preview these other audio/visual formats, ante rate of this advice, but strongly rec- I can not offer evaluative comments on ommend women adhere to it. Important their quality. instructions concerning pregnancy and

While neither nurses nor nurse-mid- exercise physiology and valuable dem- wives are mentioned as contributing to onstrations are presented at the end of preparation for childbirth, they seem to the tape. Thus, some women may lack have made major contributions to the knowledge they need prior to engaging making of this videotape. Of the 13 con- in the exercises. sultants listed in the credits, four are Dr. Ulene introduces the program with nurses and one is a nurse-midwife. Three comments about pregnancy fitness. My additional nurse-midwives are given spe- own bias regarding exercise during preg- cial thanks. nancy and the immediate postnatal pe-

riod is that there is much for women to The American College of Obstetricians gain by participating in a formal fitness and Gynecologists Pregnancy Exercise program taught by a knowledgeable, Program. Produced and directed by certified instructor versus unsupervised Priscilla Ulene and Art Ulene, MD, 1985. exercise at home. Color, sound, 52 minutes. Available in Dr. Ulene proclaims that heart rates %-inch VHS and Beta videocassettes should not exceed 140 beats per minute from Feeling Fine Programs, Inc., 3575 during the exercise regime, which is in- Cahuenga Blvd. West, Los Angeles, CA consistent with ACOG guidelines and 90068. l-800-332-3373. Purchase” other literature on maternal exercise price: $39.95 for X-inch VHS/Beta; during pregnancy. These sources recom- $9.95, LP record, $9.95, audio cassette. mend that pregnant women not exceed

70-75% of their maximal aerobic ca- pacity during exercise. Any woman over the age of 32 who actually attains a heart rate of 140 beats per minute during the ACOG regime, therefore, exceeds the recommended level of aerobic intensity for pregnancy. A more accurate formula for determination of an age based range for aerobic activity during pregnancy is: 220 minus age; multiply by 60%, then 75%. The program does allot time at ap- propriate intervals for heart rate esti- mates of aerobic intensity.

Forty minutes of the 52 minute tape are devoted to pregnancy fitness exer- cises; instructions on pelvic tilting, heart rate measurement, and a relaxation com- ponent fill the additional 12 minutes. The actual exercise regime consists of warmup, mild aerobics, and cool down periods. The American College of Sports Medicine advises that exercise regimes contain also strengthening and endur- ance type exercises; but, the ACOG Pregnancy Exercise Program appears to concentrate on stretching and some ex- tremity strengthening. Actual over- stretching of some muscle groups that could produce injury is demonstrated on occasion. Conspicuously absent from the regime are exercises specifically designed for the pelvic floor or abdominal muscles. I think that specific abdominal exercises are avoided in order to be consistent with the ACOG guidelines recommending avoidance of the supine posture after the 4th month of pregnancy; but, abdominal strengthening exercises can be done in the standing or sitting postures. I believe, further, as do Elizabeth Noble and others, that it is very important for preg- nant women to condition and strengthen their abdominal muscles in order to use them more effectively during the second stage of labor.

The program illustrates proper body mechanics for pregnant women with spe- cific emphasis on the pelvic tilt. Deep breathing to encourage maximal oxy- genation is demonstrated at frequent in- tervals.

The program is accompanied by rather jazzy music containing lyrics regarding pregnancy and infants not to my taste, although the rapid beat disturbs me the most. The fast pace of the music may en- courage women to move with and to the tempo of the music rather than to their own inner rhythm. The liveliness of the music has the potential also to encourage

112 Journal of Nurse-Midwifery ??Vol. 32, No. 2, March/April 1987