Childbirth Education Choices

by KMom

Copyright 1998-2001 KMom@Vireday.Com. All rights reserved.


DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.

Contents

 

Childbirth Education Choices

General Information

There are many different childbirth education classes that you can attend. Which one is best for you depends on your personal birth philosophy and desires. An excellent site that compares and discusses various childbirth education approaches can be found at www.geocities.com/HotSprings/9947/cbetable1.html

This FAQ, on the other hand, is different because it is about opinions on childbirth education.  After taking a number of different types of classes, Kmom has developed very strong opinions about what childbirth education should be like, and this FAQ reflects my evaluation of various programs that I have encountered.  Other FAQs on this website are more about objective evaluations and a fair presentation of all sides of an issue, whereas this FAQ is basically a basic overview of several types of childbirth classes, with my personal opinions about each type added.  Keep this in mind as you read, and feel free to disagree or try a different approach if you wish.  

A word about my biases for the sake of fairness---after taking several different types of birthing classes, going through three very different labors (one highly medicalized and two not), and a great deal of reading about childbirth issues, I have developed strong opinions. I strongly believe in: 

I strongly favor natural childbirth but know that there are occasionally times when certain interventions become necessary.  However, I strongly believe that parents must make informed choices about these interventions and that fully informed consent is often not practiced by many providers.  I believe that many childbirth education programs do not prepare parents to be the informed and assertive health consumers they need to be.

Over time, I have seen that many childbirth education programs also do not adequately prepare parents for some of the challenges and decisions they face.  In particular, few childbirth classes adequately educate and prepare parents for meeting the challenge of coping with labor without medications, or for the difficult decisions about medical interventions during birth.  Much more must be done. However, while pain meds and interventions are vastly overused, they can be helpful in certain situations as long as the parents are well-informed about their risks and benefits. 

Few programs adequately prepare parents emotionally for pregnancy or birth either.  Most programs emphasize the technical aspects of birth only, and have very little time for exploration of feelings or birthing wishes.  I also strongly believe in the importance of breastfeeding for the health of both the mother and baby, yet not enough is done in most childbirth education classes to promote and adequately prepare for either natural childbirth or breastfeeding.

I strongly feel that parents need much more information about being effective health consumers, practice of relaxation and coping strategies for labor, exploration of priorities and feelings about birth, and information and support for breastfeeding than most childbirth education programs offer.  Those are my core beliefs about birth and childbirth education classes, developed over time through lots of reading and varied personal experience. However, I fully support the importance of individual choice. Each person's situation and needs are different, and birthing choices must be individual, not one-size-fits-all (large women know how well that works!). I strongly encourage readers to carefully research all options, to fully explore their own personal feelings about birth, to become an informed consumer, and then choose the situation that's best for them. All of these factors are going to influence which type of class will be most effective for YOU.

Finally, a disclaimer---I am certifying as a childbirth educator with the Birth Works program. After taking quite a wide variety of classes (and developing such strong opinions on what childbirth education should be like), I  decided that I liked the Birth Works program so much that I wanted to certify as an instructor.  Obviously, this means I tend to favor this program's structure and process.  However, I feel that I still remain able to recognize the strengths and weaknesses of all programs, and am in a unique position to comment on them because I have taken more types than most people.  So despite what some might view as personal bias, I felt it was important to go ahead with this FAQ.  To compensate, I have tried to present an objective overview of each type and then offer my personal opinion on it.  As always, feel free to disagree or to try something different!

Special Note to childbirth educators who may be reading this section: This represents Kmom's PERSONAL EXPERIENCE and OPINION, and you may or may not agree with what she has said.  Each program represented here is given a neutral description and info on how to contact it further, and then Kmom's personal experience and opinion is added.  Please don't try to influence or change the opinions written here.  The purpose of this section, after all, is OPINION. 

 

Important Questions to Consider

Different women have different priorities and beliefs about birth.  Some deeply want a natural birth, some strongly desire lots of drugs, and some really want or believe a natural birth is better but are not sure they can handle it.   Important questions to consider when choosing childbirth education and healthcare include how much you want to be involved in your prenatal care, how many tests you want or don't want, how involved you want to be in decisions about the birth, how important it is to you to avoid an episiotomy or c-section (and why), how you feel about the use of pain medications, what kind of experience you hope birth will be, etc.  Imagine yourself giving birth to your baby in the most ideal way possible---what do you see?  The image you see in your mind will tell you a lot about what kind of birth you want (or what you must work on in order to get the kind of birth you want).   

For example, some women strongly desire an epidural "as soon as I get to the parking lot"; these women would be best served by an obstetrician and a traditional hospital childbirth education class. Some women do not want any intervention at all and feel strongly that natural childbirth is the healthiest possible option. These women would probably best be served by a midwife and a Bradley or Birth Works childbirth class. Some women have had difficult previous births (either vaginal or by cesarean) and want further information and help in preparing for a better birth.  These women, especially those seeking a VBAC, would probably be best served by a Birth Works class.  Some women have particular fears that they are having trouble working through; these women would probably be best served by a Birth Works, Birthing From Within, or HypnoBirthing class.  Most women, of course, tend to fall somewhere in between these scenarios. The degree of their feelings about birth will dictate the best course for them.

Some excellent books for exploring your feelings about birth (Kmom's favorites are in bold) include: 

If you have had a previous birth (especially one that was difficult or less than you desired), read Rebounding from Childbirth: Toward Emotional Recovery by Lynn Madsen; this is an excellent book for grieving and healing past births. If you have a history of miscarriage, infertility or other loss, Ended Beginnings by Claudia Panuthos and Cathy Romeo can be very healing (and is also appropriate for resolving issues from previous childbirth experiences as well as issues of pregnancy loss).  

Some of these books can be found at www.amazon.com, but other sources may include the Birth and Life Bookstore at www.1cascade.com, www.midwiferytoday.com, www.waterbirth.org, www.birthworks.org, or the ICEA bookstore (contact info listed below). Some public libraries can find some of these books if you ask them to run a detailed search on interlibrary loan, or many La Leche League chapters have lending libraries that may include some of these books or similar titles. It may take a bit of searching to find some of these titles, but they are well-worth taking the trouble.

Taking time to explore your feelings about birth may seem difficult or time-consuming, but it really can make a difference in creating a more positive birth experience, and in finding the right provider and childbirth education program for YOU.  

The Importance of Emotional Preparation for Birth

I cannot recommend emotional preparation for childbirth strongly enough, especially for larger women. Many larger women have strong body issues that can interfere with having a good birthing experience. Large women have an extremely high rate of c-sections, some of which is because of physician prejudice or overly-interventive treatment, some of which is due to our somewhat higher rate of pre-eclampsia and gestational diabetes, and some of which is probably due to unresolved emotional baggage that some of us may have. 

Being a large woman in our prejudiced society means having absorbed a great deal of emotional hassle over the years, and many of us have also developed a profound mistrust of our bodies after years of dieting failures. Many are also sexual abuse survivors, which adds even more emotional baggage.  However, our past and our 'emotional risk factors' does NOT have to mean huge rates of intervention and childbirth problems.  Proactively dealing with body trust issues, grieving past losses, and expressing and resolving pregnancy fears can be extremely helpful in helping us to have a more positive and empowering birth experience.  But it is up to us to reach for the healing instead of just being passive observers of the process.

The transition into motherhood is one of life's great emotional passages; it is one of life's greatest opportunities for healing and transforming past emotional baggage into powerful life lessons that we learn from. Don't let body issues and past emotional baggage derail your birthing experience; do your emotional homework and spiritual housecleaning before birth---your child will thank you for it! Large women can and DO have beautiful birthing experiences, but some find their experiences less than gentle instead, often because they have not done enough emotional preparation or selected the wrong childbirth providers. Learn from the mistakes of others---take time to emotionally heal and prepare for birth as needed!

Natural Birth Versus A High-Risk Approach

Can large women really have natural births?  The answer is yes, but you have to choose to choose your provider carefully and prepare yourself thoroughly.  The obstetric community generally views large women as being 'high-risk' even when there are no other complicating factors. This view treats large women as if they are about to 'explode' or 'go bad' at any moment and so must have the maximum amount of monitoring and testing possible. Those who ascribe to this view (and there are many) may insist that natural childbirth is not an option, that alternatives such as waterbirth, homebirth, or using a birthing center are completely out of the question for large women, and will probably insist on early induction of the pregnancy 'because the baby is going to be very big'.   (These really are attitudes that large women have run into, and quite often!)

Some large women will feel more comfortable with this kind of monitoring and high-tech intervention, while others will feel that a 'high-risk' label creates a self-fulfilling prophecy. Again, it depends on your birthing philosophy and desires. But it is NOT true that large women cannot have natural childbirth, waterbirth, homebirth, etc. Large women can and HAVE had natural and 'alternative' births. They do not HAVE to have large amounts of testing and monitoring.  However, it's important to choose a provider that does not see you as high-risk simply because of your size, and who uses more natural birth practices on a regular basis.  Many providers have an automatic  'default' setting for lots of intervention when they see a woman of size, and only a careful provider selection process will uncover a predisposition to this in some.  It is vitally important that you carefully interview and discuss issues with any potential provider in order to find the most size-friendly doctor or midwife for your care. 

Even if you did develop some type of potential complication, it does not mean that you must have a high-tech birth or cannot pursue natural childbirth. A lot depends on the specifics of your medical situation, your desires and level of assertiveness, and of course on your medical provider (and remember, you can always switch providers if necessary). Some cases are best-served by a high-tech birth with all the accoutrements and plenty of neonatal observation and care. However, many times mothers with potential complications DO still have natural or nearly-natural childbirth. Complications do not have to automatically mean interventions and a high-tech birth.  

Many critics contend that too many births have been vastly over-medicalized and overtreated, resulting in unconscionably high intervention and c-section rates (Kmom agrees!). However, it IS still possible to find providers who believe that natural childbirth is still the best choice in most circumstances, even in 'nearly normal' pregnancies. But you may have to search long and hard for one, and you may have to be willing to switch care providers even late into pregnancy if you are really committed to the idea of having as natural a birth as possible. Listen to your intuition about your provider and respect your birthing desires too. Get additional input from other types of birth providers to evaluate your level of risk and choices from a variety of perspectives, and then see if your path becomes more clear.

Being large does present a few more concerns to be careful of, but it does NOT have to preclude natural birth or a good birthing experience. But it does generally mean that you will need to be very well-educated and very proactive in pursuing the type of birth that you want, and that you must choose your birth providers very wisely. Choose one that believes in the type of birth you want----in other words, if you want as natural a birth as possible, don't choose one that puts a lot of conditions on your pregnancy or routinely insists on early inductions, etc. Conversely, if you want every monitoring test there is and could care less if you have a c-section, go to a high-risk OB, not a direct-entry midwife who believes in natural birth. In other words (as many childbirth educators say), don't try to order sushi at a McDonald's. It's almost certain you won't get what you wanted and everybody will end up annoyed. Go somewhere where what you want is likely to be on the menu and the staff will be likely to accommodate your tastes!

Of course, most women don't enter pregnancy and birth knowing clearly what they want, and usually are not informed health consumers in the beginning. They often need to take time out to clarify their value systems so that they can choose care that is most appropriate for them. The first step in this is reading up on childbirth issues and carefully discussing your thoughts and concerns with your partner. Taking an excellent childbirth education class is also a VERY important step in this direction. It can help you clarify your feelings and priorities about birth, help deal with your worries,  help expand your technical knowledge of birth issues, and help develop important questions to ask about common interventions. In short, it can help you find the way YOU want to birth, and provide help and support for you as you work towards that goal.   Below are descriptions of a few of the many childbirth educations programs you can choose from, and the relative strengths and weaknesses of each.

 

Is a Childbirth Education Course Really Necessary

Some people wonder whether taking a formal childbirth education course is really necessary.  And of course, obviously it is not.  Women have been giving birth for thousands of years without childbirth preparation courses; if they can do it so can you!  You don't HAVE to take a childbirth prep course in order to have a baby.  Your body already knows what to do!

However, childbirth courses didn't rise out of a vacuum; they became popular because they filled a real need for most people.   It used to be that birth was much more a part of the community than it is in most places today.  Most of us have never seen a baby born, or even a woman in strong labor.  Starting in the early to mid-20th century, most women were taken to the hospital, whisked away from her husband and her family, and gave birth knocked out and strapped down.  Most of us have little or no idea how labor and birth really happen. And the vastly distorted 'labor' and 'birth' we see on TV (most of which is high-risk or has some tragic twist in order to make it dramatic) is not the kind of positive and ordinary birth scene that should happen 95% of the time.  Yet this tends to be what we expect and visualize in our minds, if we even dare to visualize it at all.  A good childbirth education course can help normalize our visions and expectations of birth.  This is VERY important!

Also today there are so many choices about tests, procedures, medications, etc.  The medicalization of birth has made the process a maze of decision-making that is intimidating and often frightening.  Good consumer health information is important in helping us make those choices.  It's hard enough to make these choices during the 9 months of pregnancy, but it's MUCH harder to make them while under pressure during labor, while dealing with birthing fears, and while dealing with pain.  A good childbirth education course helps couples develop stress management techniques to deal with fears and pain and decision pressures, as well as a good grounding in the risks and benefits of various obstetric choices.  

Some moms ask whether they can just read about it in books and practice on their own.  And the answer is that of course you can do that, and that works perfectly well for some women, especially those who have straightforward uncomplicated births,  with no overshadowing birthing fears or issues.  But most women find that 'book learning' deserts them during the stress of labor, and that reading about managing labor pain does not adequately prepare them for actually doing it!  And if any kind of complication arises during their labor, these women are usually ill-prepared intellectually or emotionally for the kinds of decisions they will need to make.  

To put it more metaphorically, you can certainly learn to read music on your own, read a book on how to play an instrument, practice playing it on your own, and do decently well.  But most people do much better if they receive personalized or small-group instruction in that instrument, practice playing it often, and receive feedback from experienced teachers on the nuances of playing and interpreting a piece.  Would you really want to play at Carnegie Hall for the biggest concert of your life based simply on learning from a book? Or to give a different metaphor for the more sports-minded, would you go play in the Super Bowl for the championship game after only having read about football a few times in a playbook? 

Childbirth education is not strictly necessary since the knowledge of how to give birth already exists inside your body.  However, because:

---most people find childbirth preparation classes useful and helpful!

 

Types of Childbirth Classes Available

There are many different types of childbirth preparation classes available.  Hospital-based classes are the most common and tend to use the "Lamaze" approach, but there are also out-of-hospital courses like Bradley, Birth Works, Birthing From Within, and HypnoBirthing classes.  There are other methods as well, plus those that are independent and not affiliated with any real organization.  However, these 'methods' are the ones that Kmom knows the most about and so summarizes here.  

Most people take the traditional classes offered through their local hospitals because they are recommended by their doctors and are usually subsidized (they tend to cost $60 or less).  However, their content may be highly controlled and they tend to have a high rate of medication use and other interventions. Therefore, more and more people are opting for independent classes taught by people or organizations not affiliated with hospitals in order to receive more unbiased information and more natural approaches.  Which is right for you depends on your priorities.  

Some people take the traditional hospital class in their first pregnancy, but find that it didn't prepare them adequately for labor and birth, and so opt to change to a non-traditional class as a 'refresher' in their next pregnancy.  Other people know ahead of time that they wish a more natural, less medicalized birth and so seek out these 'alternative' classes.  Still others know that they place a very high priority on having pain medication in labor as soon as possible, and so would not be happy in an alternative, independent-style class.  And some women are undecided whether they will want a natural birth or will want to use medications, and so choose to take a course that is open and non-judgmental about pain medications, yet still prepares women to work towards a natural birth whenever possible.  Again, it all depends on what's most important to you. 

Hospital-Based Classes

These classes tend to be very traditional but the quality does vary significantly from one hospital to another. Some classes are excellent and very fair-minded while others are little more than instructions in how to be a compliant and unquestioning patient. They generally use Lamaze techniques of distraction and patterned breathing during labor; they also contain lots of simplified information about childbirth, including very basic anatomy, stages of labor, etc. 

These classes will usually contain quite a bit of information about pain medications and availability; ostensibly they are not supposed to be pro-meds but the vast majority of women who take hospital classes end up using plenty of pain medications. Classes usually begin late in pregnancy and continue until just before birth, but sign up early since they fill up quickly. 

Hospital classes are also usually quite cheap and many HMOs will pick up a big percentage of their cost, a big advantage for many couples.  Instructors tend to be certified by the International Childbirth Education Association (ICEA), Association of Labor Assistants and Childbirth Educators (ALACE), Lamaze (ASPO) or similar organizations.

For information on a hospital-based class, simply call your local hospital's health education department and ask for a list of classes and dates.  Be sure to call WELL ahead of time;  these classes tend to fill up fast.

Kmom's Opinion on Hospital Classes

I took a traditional hospital childbirth education course near the end of my first pregnancy.  It was basically good (and probably better than many hospital classes) but didn't go far enough in giving us coping techniques for labor pains, and didn't really prepare us to question or evaluate any of the decisions that were made for us during our first birth.  [Click here for a more detailed account of my experience with this class.]

Some of these classes really are well-done but in my opinion, the majority are superficial and do not adequately prepare you for the demands of childbirth. Critics contend that most hospital classes are so controlled by OB politics that they are little more than classes in how to be a compliant patient and prepare for intervention; this criticism is often a legitimate one. The problem is there is no real way to tell ahead of time which hospitals have the good classes and which do not. 

These classes are well-suited to the mother who strongly desires pain medications/epidurals during labor or who feels better with lots of monitoring. They are NOT for the mother who prefers a more natural birth or who strongly wishes to avoid a c-section if at all possible. It is my admittedly biased opinion that most childbirth classes given through hospitals are not worth taking unless you are a mom strongly determined to use pain medications. For all others, I believe that another childbirth education option is preferable.

There are some exceptions, however. Some hospitals do have excellent supplementary classes on Baby Care, Breastfeeding, Infant CPR, etc. These are often VERY well-worth taking, and I strongly recommend taking a quality class on breastfeeding in order to ease into breastfeeding more easily and successfully, and also becoming proficient in infant first-aid and CPR. These are hospital classes well worth taking if available. (Be sure the breastfeeding class is taught by a board-certified lactation consultant---IBCLC---if possible. Another alternative is to attend La Leche League Meetings for 4 weeks prior to the birth.)

 

Bradley Method Classes (American Academy of Husband-Coached Childbirth)

These classes are independent of OBs and take place out-of-hospital, so they are not likely to be controlled by local OB politics.  Therefore, they tend to present a more complete point of view. Bradley Method classes strongly emphasize excellent nutrition and proactive prevention of problems in pregnancy. Their classes promote:

Their goal is for "you and your baby to have the best, safest, and most rewarding birth experience possible."

Some parents are afraid that committing to a Bradley birth will not prepare them should complications arise, or that they must commit to having a birth without any pain medication whatsoever. Many women would like to have a more natural birth, but do not want to have to commit to forgoing any form of drugs. They are frankly afraid they cannot handle the pain of labor and will need an epidural to cope; they want fair and unbiased information so that they can choose for themselves instead of having to follow rigid dogmatic rules. Other women are afraid that if they do end up using pain meds or having interventions, they will be looked down on or derided. Couples with these reservations sometimes elect not to take a Bradley class, fearing that they will not be given complete information on all their birthing options or will be looked down on if they end up using pain meds.

These parents needn't worry---this kind of rigidity is not what the Bradley method is all about. It is about making informed choices, not about judging other people's choices. Bradley does not mandate that all women labor without drugs, nor does it label pain medications as evil. It does present information about pain medications during its classes, and it does so fairly and without condemnation. It leaves the choices up to each couple. Its position is that in the vast majority of cases, natural childbirth IS best for both mother and baby, but that each situation must be judged on its own merit and needs. It does present information about the risks of pain medications, information that is often de-emphasized or completely left out of many hospital classes, and it does take the position that medications can be a very slippery slope on the way to intervention and c-section, but it also recognizes that in some situations, pain medications can be beneficial and appropriate. 

It is not unfair or biased in its presentation of information on pain medications, but it does carefully examine all the risks so parents can make a truly informed choice, something that is lacking in many OB offices. It also carefully prepares you in alternative methods of dealing with contractions so that you are less likely to use pain meds. Reportedly, over 90% of Bradley couples do not use pain meds in their births, a tremendous success rate and one that speaks tellingly of the preparation they receive. However, if you end up in the near 10% who has pain meds or other intervention, no one should look down on you or judge you.  Of course, not every teacher approaches this philosophy the same way; some students occasionally report a judgmental attitude in some teachers or classes.  But by and large, this is not the approach taken by most teachers and classes.  

Bradley classes place a great deal of emphasis on nutrition, and women are generally required to fill out a weekly food diary, at least at first. This can be a painful exercise for women who have dieted and reported to the 'Food Police' all their lives, but the point is not to be judgmental or scolding but to help women evaluate whether they are getting enough protein, vegetables, vitamin A, C, and calcium foods each day. 

Bradley students have a checklist of foods that must be consumed daily or weekly, and some critics find the amounts of protein, eggs, etc. excessive. However, the recommendations are based on the work of Dr. Thomas Brewer, who achieved amazing results by emphasizing preventive nutrition among his patients, many of whom were high-risk. Bradley method proponents feel that the emphasis on prevention and SUPERB, careful nutrition is part of the reason why Bradley classes generally achieve such good outcomes. Furthermore, the Bradley approach is quite compatible with nutrition requirements for gestational diabetes programs or pre-eclampsia.

A few Bradley teachers do have earlybird Bradley classes available, but most parents take Bradley classes at about the same time they would hospital classes---in the last several months of pregnancy. If there are earlybird classes available to you locally, you really should consider taking them if at all possible, but later classes are still quite valuable even if that's all that is available. Classes are usually 12 weeks long and are limited to a few couples at a time in order to assure lots of individual attention (sign up early to get a spot!). If you are having reservations about your present provider or wish to find a doula for extra labor support, many Bradley teachers can recommend the best OBs, midwives, and doulas in the area to you, potentially saving you a lot of time and effort searching. 

The main disadvantage of Bradley classes is the cost. Classes generally run $150-200 and are held in private homes; the price deters many couples from taking the class. However, those couples who have scraped together the money to take Bradley classes rarely regret it and are generally very positive about the experience.  One other possible disadvantage of Bradley classes is that some OBs have very strong prejudices against them, and a few even flatly refuse to take patients who take Bradley classes.  Some OBs feel (unjustly) that the protein requirements are excessive and produce 'huge' babies that are hard to birth, or that Bradley parents are hard to work with, demanding, and rigid.  Although it's true that some OBs occasionally feel this way, most OBs and midwives are fine with patients taking Bradley classes, and those that object to Bradley classes usually do so from misinformation about the class and its nutrition recommendations.  Some OBs have objections to the 'natural childbirth' emphasis and at having their decisions questioned, but that's a good warning sign to find a new doctor anyhow!  

Further information about Bradley classes can be found at www.bradleybirth.com or by calling 1-(800)-4-A-BIRTH for a list of teachers local to your area. [Kmom is not associated with the Bradley program.]

Kmom's Opinion of Bradley Classes

I took a Bradley class with my second pregnancy.  The instructor was very nice and helpful, and gave us lots of helpful relaxation and coping strategies for labor.  There was a very fair presentation of the benefits and risks of labor medications.  The curriculum did tend to favor natural childbirth strongly, but no one was judged if they chose interventions or pain meds.  Prevention of problems was strongly emphasized.  There was some attempt to address emotional preparation for birth, but it was minimal and took a back seat to lots and lots of technical information about anatomy and birth and such (there was almost too much of this).  Although the instructor gamely tried to help us with our VBAC plans and concerns, the class was much more geared to first-time parents and I feel we didn't get the kind of specific help we needed to prepare for a VBAC. [ Click here to read a more complete account of my experience with this class.]

Bradley Method childbirth classes are overall generally good, and I do recommend considering them. Their strong emphasis on being a well-informed health consumer, their insistence on excellent nutrition and other proactive health measures, their use of natural relaxed breathing techniques instead of gimmicky breathing patterns, their focus on preparing both the mother AND her partner for handling the birth process, and especially their frequent rehearsal of a variety of labor coping techniques makes it one of the strongest childbirth education programs available.   However, a greater emphasis on emotional preparation would have been helpful.

 

Birth Works Classes

This is a fairly new entry into the childbirth education area and a very promising one. This is one of the only childbirth education classes to really address the emotional preparation as well as the physical preparation needed for birth. It also is one of the few classes available that is appropriate for parents who have given birth before, either vaginally or by cesarean. It is an excellent preparation for VBAC birth as well as for first-time birth.

Its flyer states that "Birth Works embodies a philosophy that develops a woman's self-confidence and trust in her innate ability to give birth. The classes are experiential and provide both a physical and emotional preparation for birth. Birth Works classes are taken by new parents, and women with prior cesarean or vaginal births. The program meets the needs of parents planning hospital, birthing center or home births."

The emphasis on emotional preparation, grieving and healing, and discovering belief systems before birth is probably the most unique aspect of this program. It says that "talking about obstetrical drugs, medical procedures and birth plans is straightforward. The challenge is to get today's women to develop trust and faith in their bodies." [their emphasis]   However, they also emphasize nutrition, exercise, birth plans, breastfeeding, and postpartum issues as well as traditional topics such as components of labor, pelvic body work, labor positions, comfort measures for labor, etc.

Birth Works classes are about 10 weeks long and they do encourage coming early in pregnancy (or even before pregnancy!). The disadvantage of Birth Works classes is that they are probably not subsidized by insurance and cost more than hospital classes, but the information provided is more complete and fair. And unlike many hospital classes, they teach not just cold, abstract facts about anatomy, birth, medications, etc., but also exploring one's belief systems about birth, healing from past emotional issues that might affect your ability to give birth, etc. It does believe in natural childbirth but emphasizes the importance of each woman choosing the right way to birth for her. It is "a unique and innovative approach focusing on the integration of mind, body, and spirit, a process which builds confidence that birth, indeed, works!" [emphasis theirs] Their official statements of belief are:

  1. The knowledge about how to give birth already exists inside every woman. Women's bodies are designed to give birth.
  2. A woman will labor the best wherever she feels the safest and most secure. For some that may be a hospital; for others it may mean at home or in an alternative birthing center.
  3. Birth is one of the greatest challenges life has to offer. It provides an opportunity for personal growth.
  4. While a cesarean section can be necessary at times, the current rate is too high.
  5. In most cases VBAC (vaginal birth after cesarean) is a safer alternative to routine repeat cesareans.
  6. Birth Works is a process, not a method. Birth Works seeks to facilitate a woman's or a couple's personal process in childbearing, not to impart a preconceived method of labor and birth. There is no one right way to give birth. Each birth is unique.
  7. A woman in labor deserves an environment in which her privacy, autonomy, and emotional security are protected, and her mobility is encouraged.
  8. Expectant parents should have access to information they need about obstetrical procedures. They should participate in decisions regarding the judicious use of obstetrical medications and procedures.
  9. A woman's beliefs influence her birth. Exploring her beliefs heightens self-awareness, serving as a catalyst for positive change.
  10. The emotions of a birthing woman have profound effect on the birth outcome. Women must be allowed to express all their birth-related feelings.

(copyright 1995, Birth Works, Inc.)

As with Bradley courses, the main disadvantage of this course is the cost.  Classes generally run anywhere from $100-$250, depending on the region you live in, the experience of the teacher, etc.  Although much more expensive than traditional hospital classes which are subsidized by the hospital and insurance companies, this course offers so much more that it is worth the added expense.  

The other disadvantage of Birth Works courses is that they are not available in all areas.  Bradley has been around a lot longer and has many more certified teachers all over the country.  Birth Works is rapidly gaining trainees and educators now, but there are still parts of the country where there are not any instructors within driving distance.  However, this will become less and less of a problem soon.

You can learn more about the Birth Works childbirth education program (and to locate teachers in your area) by visiting its website at www.birthworks.org or by calling 1-(888)-TO-BIRTH. Their email address is info@birthworks.org.  [Kmom was not associated with Birth Works at the time this was originally written but has since joined their training program to become a BirthWorks childbirth educator.]

Kmom's Opinion of Birth Works

Obviously, this is my favorite program since this is the one I chose to sign up with to certify as a  childbirth educator. I took a Birth Works seminar between my second and third pregnancies, again in my third pregnancy, and an adapted form of the class later in my third pregnancy.   I found the program extremely helpful in so many ways.  It was the only program I've seen that has a VBAC component available to it, yet is still very suitable to non-VBAC parents as well.  I really liked the way that it's not just for first-time parents, and that parents who have already had births share and become part of the teaching process as well.  

Lots of time is spent on clarifying birth priorities, on learning to trust our bodies, on emotional components of pregnancy, birth and parenting, as well as on traditional technical childbirth information like anatomy, benefits and risks of various procedures, etc. Particularly helpful were the visualization and relaxation exercises; my main complaint was that I wanted more of those. [ Click here to read a more complete account of my experience with this class.]

My opinion is that this is one of THE best childbirth education programs I've ever come across, and I was so impressed with it that I decided to certify as a childbirth educator with it!  It would be my first-choice recommendation to any parent, either first-time parents, or parents who have already had a birth and are looking for a refresher.  I think it is particularly valuable to women who have had a cesarean and are seeking a VBAC, and to large women who have body trust etc. issues.  Of course, as always, the worth of the program ultimately also depends on the quality of the teacher you encounter, but this is probably one of the most valuable programs available, and parents would do well to select this course.

 

HypnoBirthing Classes

HypnoBirthing classes are a new entry on the childbirth education front.  You may have seen reports on it on nightly news magazine TV shows.  They use hypnotherapy to help women relax and prepare for birth, to deal with fears about birthing, to help bond prenatally with their children, and to relax through and deal more effectively with labor pains.  HypnoBirthing was founded by Marie "Mickey" Mongan, who consciously birthed her four children in the 50s and 60s without being drugged up and knocked out like so many women in that era were (she was inspired by Grantly Dick-Reade's book, Childbirth Without Fear).  She feels she used a form of self-hypnosis to help, and eventually developed this formalized program to help other women.

A common misconception about hypnosis is that women can be made to do things against their will.  This is not true.  Hypnotherapy simply helps women go deep into their own internal resources to help them deal more effectively with fear, pain, and the powerful forces surrounding birth.  The woman is relaxed, yet highly aware and focused.  Another misconception is that women will be unconscious or not completely aware of their births.  Because they tend to be very quiet and internalized, many people around hypnobirthers may have this perception.  However, women report that they are fully conscious and know what's going on around them during the birth, can also come 'in' and 'out' of this state at will, and are able to participate fully in the joy of birth. 

Mickey contends that women can control their own levels of pain in birth, and that "birth doesn't have to hurt at all".  She believes that women can decide how much pain they want to experience through the use of individual 'pain control valves'.  Many women who take HypnoBirthing classes amaze their attendants because they are so seemingly peaceful and calm throughout the whole birth.  Although not all hypnobirthers report 'painless' or 'no pain, only pressure' births, some certainly do seem to experience that.

Nancy Wainer (author of Silent Knife, midwife, and VBAC pioneer) wrote about HypnoBirthing for the Autumn 2000 issue of Midwifery Today.  In it, she discusses how many hypnobirthers in her practice have had much easier, shorter births after taking HypnoBirthing classes.  Although she has a few disagreements with the program on the utility of perineal massage, etc., she was impressed enough with HypnoBirthing to become a certified teacher of it in the Boston area.  She writes, "One of the great benefits of HypnoBirthing is the reduction/elimination of fear around birth. Decisions made from fear are not decisions at all, they are forced reaction.  Women are then free to make real choices--about where they birth, how they birth and with whom they birth.  Fear increases muscular tension and creates discomfort that grows into pain and then increases the fear.  An old concept, but very important to HypnoBirthing."  

One disadvantage, however, is that HypnoBirthing class series seem to be shorter than the usual childbirth education classes.  Most childbirth classes last 10-12 weeks, while HypnoBirthing classes tend to be 4-6 weeks instead.  That seems very short for the amount of information and emotional processing and preparation that is most helpful for birth.  The other disadvantage, of course, is that HypnoBirthing, like other private classes, is not subsidized and so can be quite costly.  The exact amount depends on the instructor and the region you live in.  HypnoBirthing programs may also not be available everywhere.

Further information about HypnoBirthing can be found at www.HypnoBirthing.com.  If there are no HypnoBirthing teachers in your area, you might want to take a different type of childbirth education class and also seek out a hypnotherapist for relaxation training on the side.  HypnoBirthing teachers rightly caution that these professionals may not have adequate training in childbirth issues and preparation (which is why it's important to take another type of childbirth class), but while it may not be as helpful, some help is better than none.   Hypnotherapy as a concept sounds very 'far out' and alternative, but many people do find it quite helpful for many life issues, including childbirth. 

Kmom's Opinion on HypnoBirthing Classes

I took a modified HypnoBirthing class on a private one-to-one basis with a HypnoBirthing teacher near the end of my third pregnancy, to continue the work I had started with my Birth Works classes which had ended with several months left in the pregnancy. (Yes, I felt the need for a lot of support in that pregnancy!)

I had mixed feelings about the class afterwards.  On the one hand, the relaxation and visualization tapes were VERY helpful, and I used them nearly every day to relax, deal with fears, to visualize a different outcome than in previous births, to release anxieties and the need to try and control the birth, etc.  To me, this is by far the most valuable part of the class experience, and would be helpful to many couples.  

However, sometimes the class is rather dogmatic about certain issues, such as perineal massage or patterned breathing.  My experience in the class was that the instructor was a bit inflexible and not open to differences of opinion on these issues.  There was also a great deal of pressure from my instructor to 'do it right', 'stay in control', not to 'lose it', etc.  I felt a great deal of performance anxiety as a result! I think my experience with the class may have been weakened by the fact that I had a less-than-effective teacher.  I also question whether a short class series like this is truly adequate for covering the important issues in birthing plus getting all the relaxation training; this seems to be a weakness in the program in my opinion.  [Click here to read a more complete account of my experience with this class.]

HypnoBirthing classes are appropriate for all types of parents, but probably most effective for those wanting a more natural birth, those having difficulty dealing with anxieties about labor and birth, those strongly afraid of labor pain, and those who have had past difficult births.   In my opinion, the program has significant strengths (the relaxation tapes and components, the effective use of visualizations), but not all educators with the program may be adequately trained and the program tends to place a lot of performance pressure on its students.  As with any program, the program's effectiveness probably has a lot to do with the strengths and weakness of any individual teacher.

 

Birthing From Within Classes

Another relatively new childbirth education program is the one based on the work of the authors of Birthing From Within.  It places very strong emphasis on exploring feelings and often uses artwork as a medium to discover unconscious feelings and beliefs.  It also tends to use a lot of journal-writing as well.  "Left-brained" people might find this class more threatening, but often once they get past their initial reluctance, many report finding the class very helpful and the exercises very freeing.  Like Birth Works, this is one of the few classes to adequately address emotional preparation as well as physical preparation.

This class probably is most useful to those highly interested in natural birth, and those who tend to be open to using artwork and journaling as a medium for exploring feelings.  People who are very analytical and 'left-brain' oriented may also find the class extremely illuminating, but only if they can get past their initial hesitation over the  'touchy-feely' exercises and take a leap of faith.  

Others who might find it especially helpful might include those who have had past difficult birthing experiences, who have a lot of pregnancy or parenting fears they are having trouble dealing with, those who have had past cesareans and are seeking a VBAC, or those with previous pregnancy losses such as miscarriage, stillbirth, or adoption surrender.   However, many 'ordinary' first-time parents would probably find the class useful as well. 

Authors Pam England and her husband Rob Horowitz have begun training educators in this approach, but it is relatively new and unfortunately it may be hard to find someone in your area that can offer these classes.  You can find out if there is a class in your area at www.BirthingFromWithin.com. (URL used to be www.birthpower.com but has apparently been changed.)  

Kmom's Opinion of Birthing From Within Classes and Book

I have never taken a Birthing From Within class and so cannot speak of this class from personal experience, but I have read the book and think very highly of it.  Many of the exercises in the book are quite valuable, and if you take the chance on doing them, can be quite illuminating.  I have heard anecdotal reports from others who have done these workshops or training and have indeed found it quite illuminating.

Many people (especially some guys) would probably find the class a bit threatening at first, and some would find the art and journaling exercises silly or 'too alternative' for their tastes.  Its approach is probably not for everyone.  However, if you do not have a good Birth Works course in your area but do have a Birthing From Within instructor in your area, it might be a good alternative.  Even if you do not get to take a Birthing From Within class, buying the book as a supplement to whatever other childbirth class you take is a worthwhile investment.  Most women who have this book say that it is one of their favorite pregnancy books of all time.  Not having taken the course, I hesitate to recommend the course without reservations, although it sounds good.  However, I do highly recommend the book.

 

Childbirth Education Alternatives

What if you would like a Bradley or Birth Works-type class but there are none in your area?  

This is a dilemma faced by many women, especially those in more rural areas. There is no clear answer; a lot will depend on your priorities. You need to decide on your priorities, and if you are motivated, then start thinking creatively! Reading lots of labor books is a good start, but doesn't involve actual hands-on training with an expert, and book information tends to fall away when confronted by the realities of labor. You need to have labor coping techniques well-rehearsed so that they become second nature instead of having to try to remember 'what the book said' in the middle of a contraction. Kmom can't emphasize enough the importance of regular, ongoing practice of labor techniques with an expert in the field. It really can't be replaced.

One option that has worked for others in the past was to hire a Bradley or Birth Works instructor for private classes and then drive there for a couple of weekend sessions instead of going for 12 weekly classes. Hiring a private hypnotherapist may also help, as noted above.  Although it is most helpful to have the information overload, values clarification, and  practice of relaxation exercises spread out over a number of weeks instead of concentrating it all in one or two weekends, having more concentrated versions of this is better than having none at all.  Many women have been able to work in birthing classes in this way.

Another option is to hire a local midwife or doula (professional labor assistant) to work privately with you for your childbirth education needs, while still going to your original provider for prenatal care. If there is no local midwife or doula to help you, consider hiring one in another city to come to you (or vice-versa) for one-on-one classes. Hiring a midwife for your main care is often an excellent choice in this situation, since the really good ones take the time to do any necessary childbirth education during their prenatal care sessions and will often spend an hour per appointment with you. Many birthing centers or family practice organizations run their own birthing classes in the community; these are often quite good too BUT you need to inquire about their philosophy because some are simply like tame hospital classes in a private setting. But all possibilities are worth investigating

Not having access to quality childbirth education programs that emphasize consumer awareness and truly informed decision-making can be a difficult quandary. There are no easy answers in this situation. However, many women have gotten through this challenge by engaging their creativity. You need to see if you can find answers that suit YOUR situation.

 

Kmom's story

Due to unusual circumstances, I have been through 4 different childbirth education programs in my 3 births. It wasn't anything that I planned, simply the way circumstances turned out. But it does give me a unique perspective on the childbirth education question!  In a nutshell, although each program has had its own strengths and weaknesses, I ultimately preferred Birth Works overall (and have chosen to certify in it). But I think different programs suit different people's needs, and what's best for me may not be the best for everyone.

Traditional Hospital Classes - First Pregnancy

In my first pregnancy, we took the standard hospital childbirth education class, as most couples do. This was not a total wash-out---I learned many things about anatomy and birthing that I did not really understand before. We also saw some cool videos and audio-visual aids that were inspiring or helpful. The instructor was very knowledgeable and nice, and a cut above most hospital instructors---we did receive pretty fair assessments of the risks of labor drugs and episiotomies, for example. Still, the overall tone was that most of the hospital procedures were appropriate and we should ask questions--but not too much. There was little to no information on emotional preparation for birth, only a small amount of information on nutrition, and natural childbirth was de-emphasized. I got the feeling that the instructor was a bit more radical but was carefully walking a line between the giving information she thought was important versus pleasing the doctors who sponsored her program.  The class was also fairly large and it was hard to get any individual attention.

We did have time each session to do relaxation exercises and some contraction 'rehearsals'. The techniques taught were the traditional Lamaze techniques of breathing patterns, distraction, and focus on an outside object. But we didn't do nearly enough preparation for handling labor, not at all!  I could tell even then that the relaxation exercises etc. we did were not going to be enough. Because we moved to a different state during the classes, we did have to miss the last two classes, the ones on cesarean birth (!) and postpartum issues. But we did  receive the most important parts of the class and practiced the relaxing and breathing techniques, so I feel I can comment on them.

When we got to labor, these techniques did NOT help much at all. It's true that my first labor was much more difficult than most, and some women do find these techniques enough for them, even though I did not. And these techniques did help some----they got me through the first 6-7 hours of an induced pitocin labor without any meds. However, the combination of a relentlessly increasing dose of pit, overwhelming and continuous contractions from the pit, an amniotomy (where the doctor breaks the waters), and a malpresentation causing serious back labor made it impossible to continue laboring like that. I elected first IV meds, then an epidural, which in that case was a wise decision. However, the end result, not surprisingly, was a c-section. I really felt deserted by my 'preparation' and was unprepared for the emotional aspects of labor, birth, and recovery, though I did at least manage to preserve breastfeeding and escape the post-partum depression so common to c-section mothers.  But in no way did I feel adequately prepared for a real shot at a natural birth.

The emotional recovery from my overwhelming labor and the horrible trauma of my c-section (the anesthesia was not adequate; I felt the surgery intensely) was difficult to integrate. When I became pregnant with my second child a year later, I became determined to avoid induction and as much of the intervention as possible in order to have a better birth. There was NO way I wanted to repeat THAT experience! I also recognized that I needed better coping techniques if I was going to labor naturally as much as possible. 

Bradley Classes - Second Pregnancy

Although we didn't really want to do an entire childbirth class series again, we felt that it was obvious that the hospital class had not adequately prepared us for the complex decisions we'd faced, nor were we as well-prepared for avoiding drugs as we would like to have been.  In addition, the new wrinkle of trying for a Vaginal Birth After Cesarean (VBAC) convinced us that although we'd get some repeat information, further childbirth preparation was probably a good idea.  So we enrolled in a Bradley class at 6 months or so. It was expensive (about $160) but well-worth the time.

My husband was a reluctant participant at first, but was converted to its usefulness by the time the class ended. We both found it somewhat helpful in dealing with what had gone before, though the class was not specifically about that. And we both REALLY appreciated the great amounts of time devoted to relaxation and labor coping techniques, and he really felt that the emphasis on preparing the coach for his role was vital (he'd felt really alone and helpless in trying to help me through my difficult first labor). The Bradley emphasis on natural, deep abdominal breathing was also MUCH more effective for me, and their preparations really helped me in labor. Coping with my second labor (even the back labor) was SO much easier, and my husband felt much better about his role. We also hired a doula (professional labor support) to give both of us expert support, which also aided us greatly.

The disadvantages of Bradley classes were that they were mostly for first-time parents, and a lot of the information was a repeat for us. It was still worth doing, but I'd wished for a program specifically with these techniques but aimed at second-time parents and with a strong VBAC component. My instructor knew little about VBACs and while she was great at trying to help anyway, I felt like we were both groping around in the dark. I want to emphasize that the teacher did a fine job trying to help us all she could, but she just didn't know that much about VBAC resources or issues.  I have since found resources and books that could have helped me a lot then, had I only known where to search for them, but I did not have them in time for that labor. Oh well! 

We went into labor spontaneously and labored well at home and in the hospital, even utilizing water during our labor at the hospital.  The Bradley relaxation techniques (plus the doula's help) were very helpful in coping with labor, although this labor was not as painful or difficult as the first.  Still, even though we ended with another c-section (due to malpresentation), it was a MUCH better birth, and the surgery was not a horror this time, partly due to my assertiveness about things important to me as learned in my Bradley class, and partly because I had my doula and midwife there advocating for me.  But I still wished for a class that addressed past births instead of only first-time parents, and one that was specifically about VBACs. VBAC classes are offered in some hospitals, but they are often a short-circuit to intervention and repeat sections instead of looking at the issues carefully and fairly. I knew those were not for me anymore; I'd outgrown them. 

Birth Works Classes - Third Pregnancy

Then I began to look into Birth Works classes, which seem to fit the bill in so many ways! Emotional healing from past births, attention to the needs of second-time parents, emphasis on VBAC issues and avoiding unnecessary cesareans.......sounded great! I looked up the things instructors had to do to certify; the required list of reading was very exciting and refreshing, and it echoed my growing belief that the emotional side of birth and healing from past experiences is an important and overlooked component of birthing.  I also liked the papers and other research and activities that were required.  However, there weren't any classes in my area, and honestly, I was scared to start a new pregnancy because I felt so restricted in provider and birthing choices in my area. I really felt like I wanted to take a Birth Works class, but it just didn't seem to be an option for me.  I felt boxed in and unable to make any decisions to move forward.   

In the meantime I went to a terrific workshop by Nancy Wainer Cohen (author of Silent Knife) on healing and grieving birthing experiences.  It was a very cathartic weekend.  I did not resolve everything all at once, but I was finally able to start making hard but gratifying progress towards healing and decision-making about my next birth.  I followed up Nancy's workshop by attending a Birth Works Training Course.  Honestly, I mostly signed up because I couldn't find a Birth Works course locally to take.  I'd already read or decided to read most of the books on the required reading list, and I had already amassed so many childbirth books and articles that I thought I was already starting towards becoming a childbirth educator anyhow, so why not do it with Birth Works?  But doubts and second thoughts plagued me.  I figured I was going overboard on this birth thing! 

But slowly I began to see that it was just what I needed.  Little by little I began to see the sense in the way their course was structured, in the approach they took which emphasized sharing and emotional learning, which emphasized women exploring and finding their own paths, which placed such careful attention on the images women see and imagine about birth, which emphasized the importance of baby position (the issue that had caused my 2 c-sections!), and which strongly emphasized emotional preparation for birth as well as the usual physical preparation.  THIS was what was missing from my previous classes!  I came away ready to work hard on completing my training requirements, and inspired enough to take a leap of faith and start working on a new baby.  

We conceived immediately, and things went well at first.  However, I began to experience more uncertainty about my choices, fears from previous births, and the re-emergence of difficult family issues.  Something deep inside told me I needed to take a Birth Works class again, so I registered a second time and re-took the training course.  It was even MORE valuable the second time, and I'm so glad I listened to my inner voice!  I felt so silly re-doing it, but somehow I just knew I had to.  And I found the courage this time to do a healing and grieving exercise with the trainer, reliving and working on healing that terrible experience of *feeling* the surgery of my first cesarean.  It was terribly hard to relive that, and I felt emotionally wrung out after we finished.  But I also knew that I had just taken a HUGE healing step, and that suddenly I could really envision myself having a normal birth again.  I really felt I created new possibilities for myself that weekend.

Although I was not interested in doing another whole childbirth series, I did decide to follow-up the work I'd begun that weekend with a modified Birth Works class at home (one was now available, although with a big commute).  I took the class with another BW Trainee who was seeking a VBAC.  Because we both were knowledgeable about birth already, we negotiated with the teacher to omit the parts of the class that were redundant for us and to spend more time on the more pertinent parts.  We spent a LOT of time on the emotions and healing and body-trust part of the class series!  Although this teacher was great and what we did was VERY helpful, I'd wished we'd spent even more time on visualization and relaxation. Still, it was a terrific class.

HypnoBirthing Classes - Third Pregnancy

After the BW class was over, I still had several months of pregnancy left and decided that I needed even more reinforcement of the visualization, trust,  and relaxation components, so I contacted a HypnoBirthing teacher in the area.   Again, I saw no need to do the entire class series, so we arranged private one-on-one sessions to cover the issues most pertinent to me.  We developed relaxation tapes specific to my situation and fears, and she helped reinforce the best parts of the BW class series.  This part of the HypnoBirthing course was extremely valuable to me, and I would recommend  hypnotherapy and relaxation tapes for pregnant women anytime!  

However, I was disappointed with the HypnoBirthing class in some ways too.  By now, I had strong feelings about how childbirth ed. should be handled, and I felt that this teacher was much too dogmatic.  She absolutely INSISTED that perineal massage was vital and we MUST do it, she placed an awful lot of emphasis on what I felt were gimmicky breathing patterns, and I felt a great deal of pressure from her to 'do it right'.  In other words, if I 'did it right' I would feel little if any pain in the birth, and I would stay 'in control' the whole time.  There was just an awful lot of emphasis on 'staying in control', not 'losing it' during the birth, and 'doing it right'.  I felt like if I did feel any pain during the birth, I must be a failure at the whole thing.  

At the end she showed tapes of women who went totally natural but who barely moved during labor; hardly a grimace was seen.  She did show one tape of a woman who started to 'lose it' and get 'out of control' during pitocin augmentation, but they showed the teacher helping to 'bring her back' and get it back together.  The implication was that she panicked and lost control, tsk tsk tsk, but look, see, we got her back under control.  

Although many HypnoBirthing women have had totally quiet, virtually painless births ("no pain, only pressure"), I wondered what percentage of them had really experienced things this way.  When I asked, no statistics were available, nor did they have stats on how many women had had cesareans, natural births, etc.  I felt it weakened their claims that they didn't actually keep track of how women did and felt afterwards, and I just felt a very strong component of judgment from them if you didn't experience it the way they felt you should.  

My third birth, as you might have guessed, was a very painful one, despite the HypnoBirthing training.  The baby was probably in a position where his elbow put a lot of pressure on my sacrum, causing intense labor pain, and we think my cervix may also have had some scar tissue that was quite painful to resolve.  Although the relaxation and breathing etc. helped me get through hours of labor well, things became extremely intense after we broke my waters to get more pressure on the cervix to help it dilate.  At that point, labor became extremely difficult to deal with, and the hypnotherapy didn't help much.  I certainly was feeling a whole lot more than just pressure!  

Now, this was not just me being a wimp---my second labor was all natural until just before the c/s, and even with that baby being posterior, it was not that hard until about the 3rd hour of pushing.  So I'd done natural labor before without it being a big deal, but this third labor was like a whole different matter.  It was VERY painful and very hard to deal with.  Eventually I decided to go in for an epidural, because I just didn't see how I would last for a VBAC without one.  [The short version after that is that while getting the epidural, I shifted my hips somehow on the bed in a way that resolved the baby's position, and I began pushing before we could actually finish the epidural.  I finished dilating and the baby was born within a short time--vaginally!  So I did have a VBAC, and I did not have an epidural, but it WAS very painful until baby's position changed.]

Although I was deliriously happy to have a healthy baby and absolutely ECSTATIC to have had a VBAC, I did feel brutalized by the amount of pain I'd experienced.  Although the HBirthing teacher did not outwardly condemn, I did feel like she presented subtle messages that I'd failed, 'lost control', like I'd let my training slip away from me.  I thought it was very telling that while I was eager and happy to share my birth with my Birth Works teacher, I did not want to share it with the HypnoBirthing teacher.  I felt judged.  I also felt a bit set up by the expectations that if you did it right you would not feel any pain.  Although some HBirthing women experience birth that way, I'd bet that not all do, and that dealing with the pain might then be a difficult shock.  I really think that women are sort of set up for failure by this expectation.

However, in fairness I'd also like to add a caveat---that like any other educational endeavor, the method itself pales in comparison to the influence of the teacher.  If you have a great teacher, many different 'methods' will work.  If you have a lousy teacher, it doesn't matter how great the method or curriculum used is, it's not going to be that helpful.  I know that Nancy Wainer is an outstanding teacher, for example, and I would bet that if I'd taken my HypnoBirthing class from her, I might have felt different expectations, and I'm sure I wouldn't have felt judged like I did.  I have talked with others who have taken her class, and they weren't given the expectation of having no pain at all or for being totally quiet during labor.  And while they did experience pain in labor even with HypnoBirthing, they did find it to be an effective tool to help deal with the pain and keep it from being overwhelming.  And like me, they did find HypnoBirthing extremely helpful in dealing with fears, visualization, and relaxation ahead of time.  So a lot must depend on the teacher involved.  

One further reservation about HypnoBirthing is the training of the teachers.  I met a woman trained in HypnoBirthing at a childbirth conference while I was pregnant with #3, and since I was interested in it, I asked her about how to find someone in my area.  She actually cautioned me about HypnoBirthing---a trained teacher in it telling me it might not be for me!  She said that she felt like it was a wonderful method when used by trained hypnotherapists, but that when she took her training, she didn't feel like they were given adequate training in hypnotherapy and she didn't therefore feel like she was really prepared to teach it adequately.  So although she was certified as a HBirthing teacher, she didn't feel like she ought to be teaching it, and would send people who called her about it to another HBirthing teacher in the area that was actually a trained hypnotherapist before she became a HBirthing teacher.  She advised me to find someone who was a hypnotherapist as well as a HBirthing teacher.  I thought that was a very telling comment.  [Side note: the HBirthing teacher I did find in my area WAS a trained hypnotherapist before she became a HB teacher, but it didn't seem to help!  I think it just comes down to the fact that she wasn't a very good teacher.]

So my reaction overall to HypnoBirthing is that it has the potential to be a very helpful class *IF* you get one that is already well-trained in hypnotherapy first and *IF* you get a great teacher who doesn't get too caught up in the dogma of the class and the expectations for a painless birth.   I found the hypnotherapy part of it extremely helpful for dealing with fears and anxiety from the terrible c/s I'd had previously, and it was really GREAT for helping me visualize a normal vaginal birth.  If I were to have another child, I would probably choose to see a hypnotherapist to continue that work, but I would NOT go back to the HBirthing teacher I had this last time.  

Kmom's Summary

As large women, most of us have been taught to distrust our body and think of it has unhealthy, diseased and dysfunctional. Many are actually malnourished from years of dieting and deprivation, and we encounter great negativity from family and friends as we consider or enter pregnancy. All of this negativity leads many women of size to a profound distrust of our bodies and doubt about our ability to have a normal, natural birth. 

A really well-done childbirth education class can help with this, and can help reclaim our roles as birthing goddesses!  I feel that access to a truly qualitative childbirth education program that emphasizes both health consumerism and emotional preparation for birth is especially important for women of size, and I would urge women of size who are reading this to not accept a less-than-adequate childbirth prep class, but to empower themselves and to go out and find a wonderful class that emphasizes the healthy and natural process of birth, that helps women find their own priorities about birth, and helps them find the tools and inner ability to live their birthing dreams.  

I think that my third birth was all about reclaiming health and trust in my body, about emotional growth and healing as a person, and about becoming more assertive in my own health care. It was not an easy birth, but when I think of all the emotional and spiritual growth I made in that pregnancy, I know it was a valuable journey.  And I think the Bradley, HypnoBirthing, and especially the Birth Works classes and training in particular were especially important to making that journey.  

My wish for others is that they find a great childbirth education program, one that suits their needs. Don't just accept the easiest or cheapest available, but search for the one that's right for you.

 

Conclusion

Childbirth education courses are important because they help people transition into parenthood, they impart important medical information so parents can make more informed choices, and they help parents physically, emotionally, and mentally rehearse for one of the most challenging and rewarding experiences of their lives.  Probably their most important function, however, is helping parents clarify their beliefs, ideals, and priorities for birth, understanding how cultural context and personal experience influence birthing, and to help parents understand and proactively deal with their anxieties or fears.  There are so many birthing choices and decisions to be made; childbirth education helps you clarify what's right for YOU.

Whatever birthing facility, provider, or childbirth education class you end up using, it is most important to find ones that match your birthing philosophy, needs, and personality. You want to find people who believe in your ability to have a healthy pregnancy and birth, who will treat you with utmost dignity and respect, who will give you a well-rounded education on care decisions, help you create your own individual birthplan, and then commit to helping you towards the best possible birth experience under your specific circumstances. Remember that no one can guarantee a perfect birth, but becoming well-educated on important issues, practicing laboring techniques and exercises religiously, and choosing a provider that supports your birthing choices are vital first steps. Read, read, read up on childbirth issues and related topics, ask the tough questions, and listen to your inner voice.

Some people spend less time and research on childbirth issues than they do on buying a car or other major purchase, and they often have cause for regret afterwards. If you choose a provider and then have reservations about your choice after taking your childbirth education class, don't feel that you are stuck; care can be switched at any time during the pregnancy if necessary, even quite late. Honor your intuition. Choice of provider,  facility, and childbirth education course is one of the most VITAL and telling decisions you make in pregnancy! Don't abdicate your responsibility in this area. Choose wisely and well, and  with great forethought.  Find a childbirth education choice that will challenge you and support you in having the best birth possible!  You and your baby deserve it.

 

References

Klaus, Marshall (M.D.), John H. Kennell (M.D.) and Phyllis H. Klaus (M.Ed, C.S.W.). Mothering The Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth. Reading, Massachusetts: Addison-Wesley Publishing Company, 1993.

Highly recommended! Excellent book summarizing the help that a doula (professional labor assistant) can give you in your labor; cites medical studies to support its positions. For example, a meta-analysis of 6 different doula studies showed that the presence of a doula reduced the c-section rate by 50%, length of labor by 25%, oxytocin use by 40%, pain meds by 30%, the need for forceps by 40%, and requests for epidurals by 60%. Also helps you find and choose a doula and gives a number of contact organizations to aid your search.

Kennell, John H. (M.D.) and Dr. Susan McGrath, Case Western Reserve University, Unpublished Study (as reported in Yahoo! News, Health Stories, May 6, 1998).

As yet unpublished, this study looked at 555 first-time mothers who were randomly selected to labor with the aid of a doula. The arm of this study mentioned in the Yahoo news article noted that of the women who were induced for medical indications (n=44), those who had doula support during their induction had a c-section rate of 20% vs. a c-section rate of a whopping 63% for those who were induced without a doula. However, it must be noted that the size of this arm of the study was so small (only 44) that distortions of results can occur and the power of the study is too small for permanent conclusions. Obviously, these results are so potentially significant that this question should be replicated again with 'gold-standard' studies of greater size and power. But in the meantime, women who face the likelihood of a possible induction might well consider hiring a doula for help.

McCutcheon, Susan. Natural Childbirth the Bradley Way. (Revised Edition.) New York: Penguin Group, 1996.

Summarizes the Bradley Method approach to labor and birth; generally the best Bradley book. Some Bradley writings are a bit patronizing to the mother, but the information is really invaluable and it's a good idea to get past some of the style awkwardness in order to benefit from the great info and ideas. Reading this is a good intro to birth issues, but Kmom cautions against using only the books and not taking the classes. The classes have so much hands-on info and rehearsal of coping strategies that they are MUCH more valuable than simply reading the book. Be sure to do BOTH.

Panuthos, Claudia. Transformation Through Birth: A Woman's Guide. Westport, Connecticut: Bergin & Garvey, 1984.

THE best book on emotional preparation for birth around-----HIGHEST recommendation! Unfortunately, this book is now out-of-print, but the Cascade/Birth and Life Bookstore has a stockpile of some left. Kmom highly recommends getting one-READ THIS BOOK.

Baldwin, Rahima and Terra Palmarini Richardson. Pregnant Feelings: Developing Trust in Birth. Berkeley, California: Celestial Arts, 1986.

Another very good resource for preparing emotionally for birth. This one is in a workbook format and addresses both the mom and her partner. Some of the dialogue exercises are a bit hokey, but there is still much insight to be had from the book.

Madsen, Lynn. Rebounding from Childbirth: Toward Emotional Recovery. Westport, Connecticut: Bergin & Garvey, 1994.

Superb book for addressing the difficulties of a previous birth experience and grieving/healing them. Another HIGHLY recommended title, and fortunately, one still easily found. www.amazon.com has it, as do many other bookstores. If you had a difficult birth or a previous c-section, READ THIS BOOK.

Peterson, Gayle, PhD. An Easier Childbirth: A Mother's Guide for Birthing Normally. Berkeley, California: Shadow and Light Publications, 1993.

Another book on preparing for childbirth emotionally as well as physically, with the advantage of being easy to find. Not as valuable as Transformation Through Birth but still worth reading. The author is a leading authority in this area and has written a number of valuable books.

 

Support Organizations and Contact Info

ALACE (Association of Labor Assistants and Childbirth Educators) - provides training for childbirth educators and labor assistants, consumer referrals, and has publications like "Special Delivery".

DONA (Doulas of North America) - provides referrals to those looking for a doula (labor assistant) to help them through their labor and birth. To find a list of doulas in your geographical area, email askDONA@aol.com and specify your area. Also trains and certifies those wishing to become a birth doula.

NACC (National Association of Childbearing Centers) - collects and disseminates information on birth centers staffed by certified nurse-midwives and physicians. For list of birth centers in your area and guidelines on how to select one, send to the address below. Include $1 for postage and handling.

Other Birthing Centers - may be found in yellow pages locally, through parenting magazines, through midwifery organizations, or through local childbirth educators. www.BirthCenters.org/customizedguides/ is a webpage that has info on how to choose a birth center, questions to ask, basic info, and a list of their affiliated birth centers around the country.

ACNM (American College of Nurse-Midwives) - provides information regarding nurse-midwives around the country. Nurse-midwives are certified as nurses before taking classes and professional hands-on training in midwifery. See the websection on Finding a Size-Friendly Provider for further discussion of the differences between various types of midwives and their training process.

MANA (Midwives Alliance of North America) - organization of mostly Direct-Entry Midwives (DEMs) or licensed midwives. These midwives are usually not RNs before becoming midwives; they usually do their training in hands-on programs. Most are usually well-qualified and well-trained but since the training is not standardized everywhere, lots of questions about training and experience are appropriate. DEMs mostly attend births at home and at birthing centers. This organization promotes midwifery as a 'means of improving health care', encourages cooperation among midwives, and improves quality and availability of educational opportunities for midwives.

Association of Ontario Midwives - provides referrals to midwives in Ontario, Canada

California Association of Midwives - provides information on midwifery and referrals to CA midwives.

Informed Homebirth/Informed Birth and Parenting (IH/IBP) - provides information on alternatives in birth and parenting, plus referrals to midwives, childbirth educators, and birth assistants. Also has books and videos.

Bradley Method Childbirth Classes (formerly American Academy of Husband-Coached Childbirth) - provides referrals to Bradley Method childbirth classes and sends free package of information. One of the better childbirth classes around; concentrates on nutrition, prevention, parent as health consumer involved in decision-making, preparing the partner to help coach childbirth more effectively, etc. Emphasizes relaxation and deep natural breathing over external distraction techniques of other philosophies; uses lots of practice of relaxation and labor support techniques. Does not disparage use of pain relief medications or those who use them, but presents realistically the risks and benefits of pain meds so that parents can make a truly informed decision about using them in whatever circumstances their birth presents them.

Birth Works - provides a childbirth education and teacher certification program designed to develop a woman's self-confidence, trust, and faith in her innate ability to give birth. Referrals to specific instructors in your area can be found on the organization's website. Excellent program for new moms and previous moms. Particularly appropriate for those who have had previous birth experience, experienced or saw a difficult birth, or had a c-section. One of the few childbirth education programs to address births that are not a woman's first birth, to discuss emotional healing from previous births, or to provide specific emphasis on VBAC (Vaginal Birth After Cesarean) as well as other aspects of birth.

HypnoBirthing - provides a childbirth education and teacher certification program to help the mother relax, release fear, and cope more easily with the pain of birth.  The main website provides information about the program; you can call to find if there's an instructor near you. There are also other websites devoted to specific HypnoBirthing teachers/classes around the country.  Do a websearch on 'HypnoBirthing' and you'll probably find several.

Birthing From Within - provides a childbirth education and teacher certification program using art and journaling to help parents explore their feelings about birth, birthing issues, previous birthing experience, etc.  Based on the book of the same name.  Website can help you find if there's an instructor near you.

ICEA (International Childbirth Education Association) - provides childbirth education certification programs, publications, audio-visual materials, workshops, and conferences.

Fat-Friendly Health Professionals FAQ - provides a list of size-friendly health providers all around the USA. Recommendations come from on-line people of size all around the country. Of course the list is limited to what has been submitted to it so it is not totally comprehensive, but it's worth checking for leads before finding a provider on your own. Also, the main emphasis has been on providers other than OBs and midwives, but there are some birthing professionals on the list and more are being added all the time. Worth checking out to see if there is one listed in your area (if you do not already have a preferred provider).

ICAN (International Cesarean Awareness Network) - provides information on cesarean birth and how to avoid one if possible; provides referrals to VBAC-friendly doctors and midwives, support groups, net access groups, and a quarterly newsletter, The Clarion. Excellent on-line resource and support group.

LLL (La Leche League International, Inc.) - provides mother-to-mother breastfeeding information worldwide; has local support groups nearly everywhere to help provide information, instruction, and emotional support to women during pregnancy and lactation. Has extensive resources available in free lending libraries or low-cost pamphlets and books; many include childbirth books and parenting books as well as breastfeeding books. On-line catalogue of materials, website with some of these articles and information, 900 number to call for counseling and support, materials on tape and in Braille for visually impaired women.

Cascade Press/Birth and Life Bookstore - great source for many childbirth education books, especially those that many not be carried by the large-volume bookstores, online or not. If you are looking for a birthing book and have not found it yet, try here! Especially good for hard-to-find or more 'alternative' books. Also carries quite a wide variety (over 5800 products!) of parenting, midwifery, breastfeeding, and health books, as well as videos and teaching kits/visual aids.

ICEA Bookstore (International Childbirth Education Association) - another source for childbirth-oriented books, though perhaps more traditional.

Birth and Bonding Bookstore - a bookstore reputed to have a wide selection of many hard-to-find birthing and parenting books; located in the Bay Area (Albany, CA).

 

 


Copyright 1998-2001 KMom@Vireday.Com. All rights reserved. No portion of this work may be reproduced or sold, either by itself or as part of a larger work, without the express written permission of the author; this restriction covers all publication media, electrical, chemical, mechanical or other such as may arise over time.


[ Back to Kmom Area ]