Why Take a Childbirth Class? : Fewer expectant parents take a birthing class today than 20 or 30 years ago. This is easy to understand. Moms are generally working and they come home from work tired and not wanting to go out again. Furthermore, many moms have decided to have an epidural already so they don't see the need for a childbirth class.
I believe, however, that being well informed about pregnancy and the birth process, will make your pregnancy and your childbirth more satisfying and in many cases safer. It will surely make you a better consumer for medical decisions. Cesarean Section rates a m re over 30% and rising. Maternal and neonatal statistics in the United States are shocking. Preterm birth rates in the US increased 29% between 1981 and 2002. The March of Dimes in 2009 gave the US a D grade for preterm birth rate. Yes, pregnant women in the US have a greater than 1 in 10 chance of have a baby born before 37 weeks. And remember that any baby born before 39 weeks gestation is considered high risk for breastfeeding difficulties.
Can childbirth classes make a difference? It depends on the class. From my own rather extensive professional experience as a Labor and Delivery nurse, many classes taught by hospitals do not produce enlightened medical consumers, but just the opposite. They teach parents to fit into the hospital birthing system without making waves. Penny Simpkins, west coast birthing guru and one of my most admired women, agrees in her comment on Vital Health Update.
There is, in fact, such a wide variety of birthing classes, that it is difficult to study the outcomes of childbirth classes. However, I believe, they are more needed today than ever, for several reason. One reason is that there is so much information available today, but a person not trained in childbirth education or obstetrics does not know what is helpful and what is harmful.
A second reason is the health and nutritional status in the United States is far from excellent. French fries are the only vegetable that some children ever eat. (They grow up to be moms and dads.) Three home prepared meals a day have been replaced with fast foods and prepackaged processed foods - high in sugar, preservatives, additives and MSG and low in all of the essential nutrients which pregnant women should get every day and preferably at every meal.
Childbirth classes may be the first time a mom has stopped to take a real good look at her diet and to make appropriate changes. Ideally this should be done before conception or very early in pregnancy. Therefore, I recommend, an early bird class within the first two months of pregnancy. This will also give you a chance to check out the instructor, take a look at what she offers and see if she will be a fit for you.
Most childbirth classes will discuss pregnancy and the development of your baby. If you know the reason for some of the things that you are feeling and how they are actually beneficial to you and your baby, they will be less bothersome. Your will also learn about what tests can be done and the risks and benefits of each. Without this information, you cannot participate in your care as an informed consumer.
Breastfeeding will be covered to a degree and you can get some of your questions answered. I believed to be truly prepared for breastfeeding a series of 4 classes at your local La Leche League group is ideal. An informed breastfeeding consumer knows what hospital practices promote breastfeeding success and which ones are detrimental. I know the hospital may have a lactation consultant and she may be very good but an ounce of prevention is still worth a pound of cure. That LC may be way over extended; she may not have breastfed a baby herself and her reason for becoming an LC may be to get an all coveted no nights, weekends or holidays position.
Have 6 to 10 new pregnant friends to discuss you pregnancy with is another benefit of childbirth classes. Many times, relationships are formed that last after your classes are over. In addition, the class may also help you discuss things about your pregnancy that worry you but you have hesitated to bring up.
A good childbirth class will teach you relaxation skills that if you practice them will be beneficial for the rest of your life. I have used the techniques that I taught in my classes to take a laboring woman in terrible pain to being completely relaxed and quiet through her entire contraction. It can be that effective.
And of course, childbirth classes will teach you about pain management. Some will give you factual information and some will also encourage minimizing your use of drugs. Without complete information, you can't make an informed decision. You may have decided before you were pregnant that you were going to have an epidural. But did you know the harmful effects of an epidural on your baby increase with the number of hours you had the epidural? There is an enormous difference between asking for an epidural as soon as you can have it (two to four) centimeters and being prepared to work with your labor until you decide you really need the epidural. By the way, the anesthesiologist is on the flour and wants to do it now is not a valid reason to get an epidural in early labor. Without a childbirth education, that is exactly what is likely to happen.
Or have you been told that it doesn't get to your baby? Epidural medications can be found in the cord blood and the Neurologic and Adaptive Capacity Scores are lower at 24 hours in babies born to mothers with epidural anesthesia.[i] These babies also show motor deficits at one month and the longer the epidural was infusing, the more apparent they were. They quit looking at a month so we don't know how long the deficits lasted. It is believed that these babies also have more pain after delivery because they lack the endorphins in their blood to give them pain relief.
Current studies do not examine the effects of epidurals on breastfeeding. Remember studies have to be paid for by someone and that affects the questions we ask, especially when we already have a pretty good idea what the answer is. Personally in a one year period working as a Labor and Delivery nurse, I went from having nearly every baby breast feed in the first two hours to about 50% who would not latch at all. This coincided with the year that Epidurals became the norm. We used them more frequently and earlier in labor.
You will also gain knowledge about tests and procedures, what they are for and the benefits and risks of each. This includes inductions of labor. Convenience inductions are a big contributor to the nation's prematurity rate. Who is it convenient for? The obstetrician! It's his weekend to be on call. If he induces all of the mothers getting close to their due date he won't have to be up so many nights and won't have his office hours interrupted. But did he tell you that the tradeoff for inducing your second baby is a labor more like your first, instead of quick and easy? Or that cesareans risk goes up? Or that babies under 39 weeks are more likely to have breastfeeding issues?
I hope this article has given you something to think about and will encourage you to investigate a childbirth class. Look for:
Small Classes (12 or less), early bird classes, strong emphasis on nutrition, a class not taught by your hospital (baby friendly hospitals may be an exception), and classes that put a strong emphasis on nutrition. Make sure the instructor has had a baby and preferably has nursed her baby. Also important topics are reviewing the benefits and risks of all interventions and tests and discussions on selecting your midwife or MD and your hospital. These are more important than picking a class because it's located close or is held at a convenient time. You will usually get what you pay for. A large roomed filled with expectant couples will be cheaper but you won't get the individualized attention you need. For more information on Pregnancy and Birthing, I recommend:
1. The Womanly Art of Breastfeeding by La Leche League International and 2. The Pregnancy Book by William and Martha Spears.
[i] Anesthesiology 83:300-308, 1995
[ii] Linda J. Smith, Mary Kroeger, Impact of Birthing Practices on Breastfeeding (Jones & Bartlett Publishers, 2010)
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