An interesting conversation ensued the other day with a long time student. She mentioned that she didn’t really like her OB. I asked her if she was planning on have a doula to help navigate the situation since she was not completely confident with her OB relationship. She said no. I then asked if she and her partner were planning to take a childbirth education class so that her birth partner is prepared to advocate for her during her labor. She said no, that she and her husband are pretty overwhelmed and afraid of the whole upcoming event.
I immediately wanted to jump on my soap box and proclaim the importance of childbirth education and how it helps enable a woman to make informed decisions about her birth. But instead, I opened the conversation up to the other students and asked those that had given birth how they felt preparing for their birth affected their labor experience. Many of them said that even though the labor did not go as they had expected, they were more confident in knowing what was going on. Many of the women also said they felt closer to their partners and that labor was an amazing experience they shared together.
From that conversation, I decided to approach this subject in two ways. One, I opened this question up (in a very non-scientific way) by asking our PYC community and friends via class discussion and social media. The second way I explored this matter was through looking at articles and studies that examined the relationship between childbirth education and a mother’s satisfaction with her birth.
My research into this subject matter brought me to an interesting study from the Lamaze Institute, “Patient’s Perspectives on the Role of Prepared Childbirth Education in Decision” This study mainly focused on the influence of childbirth education and a woman’s decision to undergo an elective induction. However, the study does explore the decline in attendance of childbirth education classes (CBE), the sources in which women receive their information and whether the information received at a CBE class was instrumental in the decision making process.
The Listening to Mothers II survey found that just 56% of first-time mothers attended childbirth education classes in 2005 compared with 70% of first-time mothers in 2001-2002 (Declercq et al., 2006)(1). One could argue with the drop in formal CBE classes and the varied sources of information available, women may be feeling less confident in their abilities to make informed decisions, which can lead to less satisfaction and higher incidents of unwanted interventions. Education equips women with communication and decision making skills that allows women to feel more involved in their birth experience and therefore more empowered and satisfied with the outcome, even if the scenario unfolds differently than expected. “Attendance at prepared childbirth class was associated with women’s perceptions of adequate preparation for and knowledge of labor induction. Nineteen percent of women who did not attend class felt they were inadequately prepared for labor induction, while 11% of women who did attend class felt they were inadequately prepared. Fifty-seven percent of women who did not attend class indicated they wished they had known specific information prior to asking for or consenting to labor induction, while 16% of class attendees indicated they wished they had known more specific information, including how much it would hurt (37%), could result in cesarean birth (25%), baby could be born too early (12%), and how long it would take (12%) (2).
The authors’ conclusion of the study stated, “Prepared childbirth classes remain a valuable experience for individuals who participated. In the present study, the majority of women who attended classes viewed childbirth educators and prepared childbirth classes positively. Women who attended classes were more satisfied with their labor and birth experience and felt more prepared compared to women who did not attend classes” (3).
Another article I uncovered from the Journal of Perinatal Education, called “The Lived Experience of Knowing in Childbirth”, highlights the value and importance of women trusting their intuition regarding their ability to give birth. As less women are receiving formal education about childbirth, they look to their care provider for this information and guidance. Authoritative knowledge invariably supersedes personal knowing. In that process, a woman’s knowledge of her own bodily functioning is minimized. As modern women distrust their intuition regarding their ability to give birth, they embrace authoritative, medical knowledge (4). Women who solely rely on the information provided by their care provider may miss out on important decision making models that are introduced in CBE classes, such as BRAIN (Benefits, Risks, Alternatives, Intuition, do Nothing) or BRAND (Benefits, Risks, Alternatives, do Nothing, Decision) and BRAN (Benefits, Risks, Alternatives, do Nothing). The BRAIN model and its variations were introduced as a tool to help couples think through any decisions they might have to make about interventions and to facilitate interaction with health-care providers (5).
Even if an expectant mother has the information and decision making tools, a spirit of cooperation must exist between the participant and her healthcare provider for that knowledge to be valued. After all, the mother did choose a particular care provider because there was a level of trust in his/her authoritative option. Two recent studies described the importance of empowerment for the participants. Using a phenomenological approach, Gibbons and Thomson (2001) interviewed eight expectant mothers and found that they all wanted to have an active role in the birth of their child. In the correlation study conducted by Goodman, Mackey, and Tavakoli (2004), personal control was a significant predictor for total childbirth satisfaction in 60, low-risk, postpartum women (6).
From the informal poll I took at the yoga studio and through social media, the results tended to have a similar theme, with women saying that whether or not their birth unraveled as they had expected, they felt more confident and better prepared having taken some sort of childbirth education class. Many of the women also commented that their partners were less apprehensive going into the experience.
“I was extremely satisfied with my birth experience because, having taken childbirth classes (and having you as my doula and prenatal yoga instructor), I felt confident that I had enough background information to make the best personal decisions on birthing day, as concerns and options were being presented to me.”
“I do feel the CBE helped. I took Bradley Method and although everything did not go according to the plan, it helped me accept that it wasn’t going according to plan. Can’t say the physical labor positions helped much since he was posterior, but there was one particular exercise/game we played during the course that saved me. And Tanya, our Bradley teacher, was fantastic!”.
“Looking back, it helped. My husband and I did it together and I am very happy we did. I had to have an emergency C-section and although it was not my plan, it was what had to be. And I am glad that I had the info and understanding when the time came. It can be an amazing time, especially when it’s your first time, but it can be overwhelming and scary too. So having some information and being able to understand as things are happening was very important.”
“My husband and I did a 6-week class, and I felt it really prepared us to work as a team. He understood his important role and was prepared for the intensity of the experience. I would do it again because we felt so well prepared.”
“I had a homebirth five years ago and was really excited about our classes, with Ellen, who rocks. She totally delivered, giving me (and my partner) confidence about the physical process, tips about getting comfortable while in labor, and providing a social support network through the other parents in the group. I also learned some great tips about infant care. One particular great one was about bathing the baby, not often, but in this beautiful way of getting into the bath with her instead of fretting over her, alone in the water, while breaking your back. (I still bathe with my daughter pretty regularly, in fact!) When I was pregnant all I wanted to do was think about that and plan for the birth and the baby so birthing class was a great outlet for that.”
In my personal opinion- it is not about trying to control your birth- which is uncontrollable- it is about being part of the decision making process when there is room for discussion. There needs to be a certain level of trust amongst the care provider you chose and a willingness to let go of a view of a “specific” type of birth. There may also be certain situations that may arise that you need to defer to your care provider’s medical assessment and capabilities. However, there are also times when there is room for discussion. This is where the knowledge, education and participation in the decision making can lead to a sense of empowerment and satisfaction!
(2) (3) Patients Perspectives on the Role of Prepared Childbirth Education in Decision Making Regarding Elective Labor Induction, Kathleen Rice Simpson, PhD, RNC, FAAN, Gloria Newman, MSN, RNC, Octavio R. Chirino, MD, FACOG, FACS