More about waning interest in childbirth education
Kim Painter, a reporter from USA Today, spoke with me a month or so ago about the declining numbers of women attending childbirth classes. Today’s article Interest wanes in childbirth classes highlights this decline but falls woefully short in continuing the conversation…a really important one. So, here’s the story that USA Today failed to tell.
Women today do get tons of information about pregnancy and birth from sources other than childbirth classes, but much of that information is inaccurate, outdated, and presented in medical terms that are difficult to understand. Too many childbirth classes withhold information because of pressure from hospitals and obstetricians who do not want women to have the full, accurate, research based information that is necessary for making informed decisions. The options that women actually have by the time they attend traditional childbirth classes late in pregnancy are severely limited. Why? Because it is extremely difficult (and often impossible) to change the practices of individual obstetricians and/or hospitals late in the game.
There is a greater need for childbirth education now than at any time since “twilight sleep” was the norm. Intervention intensive birth has resulted in nearly 1/3 of the babies born in the US being delivered by cesarean section. This is not good for babies or mothers. Hospitals and obstetricians provide standard maternity care that does not reflect best evidence. This is not good for babies or mothers.
Childbirth education needs to start much earlier so that women have the information required to make the most important decisions they will make in their pregnancy–health care provider and place of birth. These decisions will influence what, if any, options they will have.
Do women need to attend childbirth classes? Charlotte and I talk about that in our book. If you come from a family where women have given birth simply and easily with great confidence, then they will probably be your most important source of information, and support. If you have a midwife and are planning a home birth, you too will have access to excellent information and support. If you are giving birth in a hospital receiving standard maternity care from an obstetrician, excellent childbirth classes are essential if you are to untangle the web of modern obstetrics and increase your chances of having a normal (not necessarily unmedicated) birth. Reading a book or watching a video without the opportunity to ask questions, to sort out how everything fits in to the larger world of hospital birth, just doesn’t do it.
For thirty years I’ve looked forward to “going out of business” as a childbirth educator. But that isn’t going to happen any time soon. That won’t happen until women have the knowledge, the confidence and the support that my grandmother and great-grandmother had, the wisdom passed on from one generation of women to another. My mother knew “twilight sleep” birth, today’s women know “intervention intensive” birth. Neither are safe. So, despite declining numbers of women attending childbirth classes, the need persists, perhaps even more now that when the movement started almost fifty years ago.
January 7th, 2008 at 7:19 pm
I agree with Judy that the USA Today story is limited to simply describing what childbirth educators already know–attendance is waning at classes nationally (if not at Bradley classes…. but I heard different in my research)….
I beg to differ with the columnist Kim Painter, that women “want those interventions” just by virtue of the fact they received them, and found them helpful. Women go into a system where interventions are the norm, where going against that norm creates social, emotional and physical costs for laboring women as they seek to create an individual path within a narrow bureaucratic conveyor belt maternity system.
I hear from most women I talk to that they thought their own childbirth classes were not really worth it. One friend told me today that at her hospital based class, the instructor asked how many wanted pain medications, and after about 75% of the class said yes, proceeded to tell them all the downsides and risks of interventions. My friend said she felt frustrated that the instructor never addressed the fear behind the desire for meds. She attempted to use her public health knowledge to ask informed questions and was shut down by the instructor. I found last month’s NY Times article and accompanying comments very interesting in terms of how NYT readers viewed CBE. I will be analyzing those responses very closely!
In our research, most women we interviewed said they liked the classes and would recommend to their friends. Instructors noted they received mostly high scores on their evaluations. Perhaps in our area (Seattle) things are different. It would be wonderful to have the opportunity to observe more classes in other areas of the country.
Even so, my colleague and I noted that women in the classes _seemed_ satisfied, and expressed their satisfaction to us, no matter how WE viewed the instructor, in terms of quality. Our research wasn’t focused on comparisons but we couldn’t help but identify certain practices or features of a topic presentation that were more or less effective, compelling and informative.
In other words, cbe attendees don’t have a basis for knowing how to evaluate a CB educator and in any case, they most likely don’t have a choice, as they typically sign up for a TIME/DATE rather than for a particular instructor.
In our observations, Clarissa and I noted that the greatest variation between classes was not content, or philosophy, but an instructor’s individual style and knowledge. This is hard to quantify but bears further examination. What makes a good childbirth educator?
Since most people only know about the ‘old’ Lamaze (heehoo), I urge any and all Lamaze educators to log in, and post a comment on the USA Today website. If there is enough collective action, you will make an impression. Getting the word out that the system is broken, and Lamaze teaches how to manage labor within that broken system is vitally important for childbearing women today.
If you are disturbed by the fact that the article only focuses on the negative, I challenge you to ‘talk back’!
Respectfully,
Christine H. Morton, PhD
Research Sociologist
January 22nd, 2008 at 4:49 pm
One phrase in this response by Christine Morton really caught my attention. “The fear behind the desire for meds.” I think that is really worth exploring and discussing with expectant moms.
I direct and run a yoga center focusing exclusively on new and expectant moms. From my years of working with this population, I have heard many, many women express their fears of childbirth and their desire to numb out the experience. One way that many of them are dealing with this fear, is to NOT deal with it and ignore it . I ask them to expand on what the fear is. The students often say the pain, or something will happen to their baby. Many of them explained that they feel they will be more in control and more comfortable by taking a very medical route. Even after data is presented and discussions are held about the cascade effect of interventions, the majority still choose to take meds.
I believe one reason for this fear of childbirth is because we are removed from seeing it as a daily part of life. I recently went to The Farm Midwifery Center, there the midwives explained that the Amish community saw birth on such a regular basis, that the fear surrounding it was removed and it was viewed as a very normal function of the body. Somehow many of us have lost that perspective.
When did childbirth become an accident waiting to happen??!!
Respectfully,
Debra Flashenberg CD(DONE) LCCE
Director of the Prenatal Yoga Center
January 24th, 2008 at 11:49 am
I teach OB to nursing students here in Texas and my team and I have for many years presented labor support/nonpharmacological interventions as a required skills day. It really is a very abbreviated CB/DOULA class. We see the students eagerness and willingness to try. Then they go into the clinical setting and see nothing but interventions (for the most part). And, of course, Moms who only seem to want intervetions. However, we keep on thinking that if we teach enough students the “normal” concept that one day we can help break the cycle; have better informed customers of care and healthy deliveries. Your comments on what customers of prenatal care and education want is well taken…..it gives us courage and support to keep on trying to change the system. I do plan to visit the USA Today website!
January 1st, 2009 at 9:57 am
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April 4th, 2009 at 7:08 pm
[...] Giving Birth With Confidence » Blog Archive » More about waning … There is a greater need for childbirth education now than at any time since %26ldquo;twilight sleep%26rdquo; was the norm. Intervention intensive birth has resulted in nearly 1/3 of the babies born in the US being delivered by cesarean section. … What makes a good childbirth educator? Since most people only know about the ‘old’ Lamaze (heehoo), I urge any and all Lamaze educators to log in, and post a comment on the USA Today website. If there is enough collective action, you will make … [...]