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Not Just NRP Training: Karen Strange Teaches Birth from the Baby's Perspective

Practicing NRP with Karen Strange

You have to exhale the birth before you can inhale the baby.

Mary Esther Mallory

It’s easy to forget just how stimulating birth can be. Karen Strange begins NRP training with strategies for the participant to ground herself/himself (feet on the ground, breathe) and to notice what comes up (birth memories). From Karen’s perspective, it’s not just what a birth worker does, but rather, “how you are on the inside.” She instructs participants to not just “see” babies, but to “be with” babies. And she explores birth from the baby’s perspective.

Birth unfolds naturally, the baby following an embryological blueprint for knowing how to be born. Part of this innate wisdom includes “activations” and “settlings” throughout the sequence of pre-labor/labor/birth/immediate post-partum. The settlings, or pauses, are essential for a baby’s full integration, during and after birth. In this way, Karen teaches, there is a “bigger story behind it all.”

Everyone at Premier took part in Karen’s NRP training, even the office manager! “Her class is more than just NRP. It’s a confirmation of everything we know to be true about birth,” says Kim Pekin. Nikki Bias, office manager at Premier, agrees. “It’s a process that’s supposed to work even if nobody is there,” she says. “It goes into so much more depth than other trainings and focuses on birth center and home birth, so you’re getting relevant information.” One of the nurses remarked after the training that the first hour, which covered tools for reducing stress and anxiety and remaining present, was “life-changing.”

Viewing birth from the baby’s perspective, the participants learned about the baby’s body temperature at birth (it’s rather warm, so cool air is good), the integration of the nervous system, and the importance of the time for the baby’s respirations, heart rate, and blood pressure to stabilize. And they learned that the “wet, goo, slime” that accompanies the baby’s arrival is filled with essential microbes.

Karen taught the staff to observe and respect the natural “pause” that comes after birth (after ensuring the baby is okay). Both mom and baby need some time to integrate post-birth. The baby needs the pause to get used to being out of the womb, without water, and to integrate its temperature; it needs to cool down. During the pause, the baby’s pathways are opening, blood volume changing, senses turning on. And the mom needs time to “return” from the journey of birth (perhaps hormonal settling). If interruptions occur in the sequencing, mom and baby will need time to re-pattern, to integrate, to begin healing and repair. Karen teaches participants to remain grounded, to observe what the mom and baby need, to remain in a position of empathy - and also to stay aware of what comes up for the birth worker at the birth.

“We tend to do what we were taught to do, and to do what was done to us, rather than what is right, necessary, or based on science,” says Karen.

The participants learned to intubate. They learned about the numbers. But, according to Katie Black, Karen “makes it so it just flows from one step to another.” Katie completed the training on the due date of her third child. “I had two different views of the class. From the healthcare provider view, it made me more comfortable and confident with resuscitation as a whole,” she says. “From the expectant mother view, the class changed my whole perception of pregnancy and parenting. She talked a great deal about stress and anxiety and how to cope with it and how it affects our unborn children. When I left her class, I felt a weight lifted and totally prepared to have my baby.” Less than 24 hours later, Katie gave birth.

Karen’s training led to NRP recertification for the entire Premier staff (Nikki got intubation on the first try), but it also led to increased confidence in the process of birth and the baby’s wisdom for being born. As Kim remarked, her class reminds everyone that “babies tell their story of their birth and we just need to listen.”

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