Some time ago a study was picked up by the media as proving that childbirth education “doesn’t work”. This BJOG study compared two groups of women—one group had 8 hours of childbirth classes that also included information about natural childbirth. The other group had classes that did not include natural childbirth information. The epidural rates for the two groups were the same and the couples’ satisfaction levels with their births was also the same. After this media attention, several birth bloggers addressed the study in-depth. The Science and Sensibility blog in a post titled Do Breathing Exercises Work? and The Family Way Publications in Natural Childbirth Class Not Useful?
What stood out to me in the article was the emphasis on breathing techniques. There is a lot more to childbirth education than “the breathing” and if that is all the “natural birth” classes had to offer, no wonder the results were what they were! As was noted in one of the blogs cited above, it is also significant that the women were randomly assigned to either group, indicating that they did not have a strong interest in natural birth (if they did, why risk being assigned to the non-natural birth classes!), so that perhaps the personal investment element was missing. A woman has to want to experience natural childbirth in order to do so!
Another birth educator commenting on The Family Way’s blog post, made an excellent observation that I think really got to the true heart of the issue. She said, ” Until childbirth educators emphasize this key component of CONGRUENCY in their classes women will continue to seek ‘care’ from professionals and institutions incompatible with their professed desire for natural birth. (emphasis mine) All this study proved to my mind it that both types of classes offered were ineffectual in promoting the with-women model of care in labor and birth… Both types of classes failed to address the real crux of the matter…are you receiving care from a provider/institution compatible with the kind of birth you want?” I explain to people in my classes that in the hospital women’s coping mechanisms are often stripped away from them-–sometimes by force, sometimes by misinformation, sometimes by excuses. I tell them over and over again to “ask questions before their chile is roasted” (Pam England). People tell me they can fight for what they want or that their husbands are good at “standing up for me” and I remind them that birth is not a time in a woman’s life when she should have to fight for anything! The time to get good care is NOW, not while “fighting” during labor and not during the “next birth” either (see more thoughts about “the next birth” here).
So, does childbirth education matter or not? Is the birthing woman’s environment of greater influence? I don’t think we have a full answer to this question. I do feel in my heart that childbirth education has important things to offer (otherwise, I wouldn’t be in the field!), but I also know in my heart that an unsupportive birth environment can steamroller right over most of the benefits. Birth is a lived experience and as such is greatly impacted by going on in the “here and now,” rather than past learning or ideas. Recently, I shared this quote from Suzanne Arms on my Talk Birth Facebook page:
“The knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on the acceptance of the process.”
In the comments, I noted: also helpful is to birth in an environment that shares that acceptance!
In July, I attended the annual CAPPA conference and enjoyed hearing Polly Perez speak about the benefits of childbirth education. She shared the following evidence-based benefits:
- Less fear
- Student more able to take responsibility for their own health care
- Less need for medications/anesthesia
- More satisfaction with birth experience
- Life skills!
I definitely have been witness to the reduced fear as well as to the development of life skills that will continue to serve parents on the parenting journey. My own personal observations of additional benefits would be:
- Increased confidence in their bodies, the birth process, and their own capacities
- Enhanced father participation
- Increased prenatal bonding/connection with baby and positive feelings towards baby
- Reframing of birth from something to fear/greet with anxiety to something to embrace and greet with anticipation and enthusiasm.
It is hard for me to identify if these benefits carry over from my actual classes into the birth room, however, and this is an issue and question that I continue to ponder.
On a related note, here is a handout from Mother’s Advocate on choosing a childbirth class.