Effectiveness of Childbirth Education?

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:

  • Knowledge
  • 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.

2 thoughts on “Effectiveness of Childbirth Education?

  1. I most definitely think that the type of class you take is crucial to what you will take away from a childbirth class, and whether or not it is helpful to you. My first birth, I took the hospital course. It bascially told me what to expect at the hospital. I wanted to birth naturally. I had attended a natural childbirth before as a labor partner. I thought I knew what I needed. What I didn’t know, was that the doctor I chose and the birthplace was not friendly to my options. My birth ended in cesarean. My childbirth class did nothing to prepare me to fight for my rights as a childbearing woman, nor did it give me factual information on which to base my arguments or decisions.
    For my second birth, I took Bradley classes. 12 weeks for 2 hours. Believe me, there wasn’t anything left out or looked over. Bradley classes are for the folks who want all the facts, and want available to them every option for comfort measures. 🙂 A dedicated and dynamic instruction who believes in what she/he is doing is important as well. I was more than prepared to meet my birth. I was equipped with information I could use during labor. I chose a caregiver who supported me and whom I could trust to have my and my baby’s best interest in mind. It was a completely different experience. Oh, and I learned about doulas!
    Now, being a CBE and doula, I can see in some of the births I attend whether or not class was helpful to the couple. I do think that classes do a lot to help father’s/partners feel like they can participate in the process. I know it gives mothers/couples confidence to be an active participant in decision making. For me, that translated to less fear, and more satisfaction in the outcome. I also think that those who choose CBE often already have in mind the seeking of more information to help them retain the ability to be that active partcipant in decision making. I most definitely think it helps in finding a care provider and place of birth.
    I agree that place of birth plays an important role in the way a birth plays out. In a rural area, like my own, we have no choices in having a birth attended by a professional at home. And only a few hospitals to choose from, so in areas like this, I believe that CBE is important so that women can weigh their options, choose the one that is the closest fit, and learn to communicate with their birth attendant their desires for their birth.

  2. Yes, Yes, Yes!!! You hit the nail on the head here, Molly.

    Since you’ve looked at BirthWorks, you probably have a good idea of their philosophies, etc, which are very much in line with what you already listed. I tell ya, right now I so weary of talking to women after they’ve had a traumatic birth experience (not women from my classes!!) and hearing them say, “The stuff I learned in the hospital class I took I could’ve learned from doing a google search.” As my business is new, I’m in a place right now where it’s hard to convince people that BirthWorks classes are very different from the norm. And it’s difficult to explain all the intricacies…one needs to really *experience* the difference to see for themselves!

    I read a blog post a while back where a new mom was describing how she felt about epidurals. In her head, she really wanted a natural birth but was still undecided. She took the hospital “natural childbirth class” and after ALL was said and done, at the end of the class, she had the courage to ask the instructor and other women, “I need you to convince my WHY I should have a natural birth.” One of the biggest problems I see with such type classes is there is little to no emphasis put on the emotional aspect of preparation. Most likely this mother had significant, underlying fears and learning “the facts” about “natural birth” did absolutely nothing in preparing her for birth. How can a woman (or man) be expected to accept objective information when there is a massive cloud of fear and anxiety in the way?? (Obviously, too, there are many more problems with such types of classes, but you already know that!!)

    I saw a piece on Great Day St. Louis a couple days ago where the director of perinatal ed was on to “prepare moms for what to expect when they get to the hospital.” Here she was, surrounded by cervical dilation charts, monitor straps, a pelvic model…and everything that came out of her mouth was laced with fear and encouraging mothers to hold onto their passivity. Of course, I expected nothing less!! But’s it’s a sad reality when I see such things and have to remember that a large number of women learn about birth thru such exposure! Why would a woman want anything different for herself or her birth when this kind of garbage is all she’s been exposed to?

    Ok, I’ll step of my soapbox now. 🙂 Great post, as always, Molly! Your round tummy looks lovely, btw.

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