Thursday, May 28, 2009

Effectiveness of Childbirth Education

A recent study has been picked up by the media as proving that childbirth education "doesn't work" and this has been popping up in my Google Alerts all week. The 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. Several birth bloggers have 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 blog 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).

I recently finished reading the very firey and passionate 1990's manifesto on VBAC, Open Season. The author bluntly addresses the issue of transparency in maternity care and also the effectiveness of childbirth education in this quote: "If childbirth classes really 'worked,' more women would be having babies without interference. More women would be recognizing the complete naturalness of birth and would remain at home, delivering their infants with feelings of confidence and trust. More and more, midwives would be demanded. The names of those hospitals and doctors who treated women and babies with anything less than absolute respect would be public knowledge, and childbirth classes would be the first place these names would be discussed. 'You're seeing What's-His-Face? He's a pig! In my opinion, of course,' I tell people who come to my classes. I then proceed to give them the names of people who have used Pig-face. They can always ask Dr. P. for the names of people who have used him and been satisfied with their births, for balance."

Speaking of Open Season, another quote in it addressed the idea of being in the "same camp" or having "opponents." I found the perspective really useful for thinking about maternity care issues: “The moment you start thinking about other people as opponents it becomes impossible to find a solution. ‘There are no opponents in a disagreement; there are simply two [sides] facing a common problem. In other words, they are not in opposite camps, there are in the same camp. The real opponent is the problem.’” The Woman-to-Woman CBE blog mused on something similar recently in this post: Same Team...Same Team?

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