You’re smart, you’ve read “What To Expect When You’re Expecting”, as well as the more sophisticated childbirth books by Ina May Gaskin, Janet Balaskas, Sheila Kitzinger, Pam England and others, you belong to the savvy pregnant and new mom Facebook groups and you know your way around the Internet. Like most women of childbearing age, you’re convinced that you can get all the information you need to prepare for your upcoming birth from the Internet. Right? Please read on to see why this could possibly lead to some very undesirable consequences for you and your baby.
How much time and energy do you spend on planning a vacation? Dare I ask the question how much time and energy you spent planning your wedding? Surely the way in which your baby comes into the world deserves the same, if not more, careful planning? If it doesn’t matter to you what sort of birth you have and you are fine with the idea of going through the system, being cared for by those well-trained and experienced midwives and doctors who want a healthy mother and baby (but who work according to specific hospital protocols), then you probably don’t need to take a course.
However, if you want to know all of your options so that you can decide what sort of birth you would like to have, then you need a course that will explain your options. The cliché, “If you don’t know your options, you don’t have any” is totally appropriate in this context.
Helping couples integrate knowledge of normal physiologic birth and learning strategies to facilitate normal birth, understanding the impact of interventions on normal birth and promoting the attachment of mother and baby are a major focus in a good childbirth course curriculum. Knowing what questions to ask and how to have the type of birth you want (advocacy and informed decision making skills) are also key components of a quality course. For example, most hospitals routinely cut the umbilical cord immediately after birth unless the couple requests delayed cord clamping. What is delayed cord clamping? How does it benefit the baby? If it’s so beneficial to the baby, how come most hospitals routinely do immediate clamping?
While most midwives try to deliver the baby over an intact perineum (without cutting an episiotomy), many midwives still feel that it’s preferable to do a controlled surgical cut for a first birth. In many cases, the midwife won’t tell the woman that she is cutting and the woman doesn’t feel the cut as the baby is pressing on the nerves that numb the area. What is the evidence-based information regarding this issue? If you decide that you don’t want to be cut (unless it becomes necessary for your or your baby’s health and the baby needs to be born quickly), how can you try to avoid it? Is it only an issue of learning methods to stretch the perineum or do different pushing positions and techniques also reduce the likelihood of tearing?
A study published last year (http://www.ima.org.il/FilesUpload/IMAJ/0/38/19484.pdf ) and reported in Haaretz (a daily Israeli newspaper) http://www.haaretz.com/news/national/one-third-of-israeli-women-experience-post-traumatic-symptoms-after-giving-birth-study-finds-1.444401 found that “More than a third of new mothers in a study by Israeli researchers reported experiencing symptoms of post-traumatic stress disorder within one month after giving birth. These can include anxiety, irritability, difficulty sleeping and avoidance of stressful events (including doctor and hospital visits)”.
Although this is an Israeli study, the results could well be relevant to many other industrialized countries where hospital protocols often override the needs of individual women that reflect their core values.
A systematic review of 137 studies analyzing pain and women’s satisfaction with the experience of childbirth involving thousands of women in many countries concluded that “Four factors – personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making” are what constitute patient satisfaction in the birth experience. (“Pain and women’s satisfaction with the experience of childbirth: A systematic review” by Ellen D. Hodnett, RN, PhD, Am. J. Obstet. Gnecol, May, 2002). This means that a woman’s satisfaction is determined more by the emotional care she received during labor than by the physical process itself, regardless of whether or not the woman used pain relief during labor and birth or even whether the birth was vaginal or by cesarean section.
Let’s look at the issue of ‘involvement in decision making’. A quality childbirth preparation course will help the couple navigate through the maze of hospital protocols in the specific location where they have chosen to give birth. While posts on Facebook groups will reflect the opinions of the women posting, a combination of evidence-based information and how to have your needs met in the location of your choice (advocacy) can only be found in a good birth preparation course.
Some women feel that they were bullied into taking medication or were spoken to in a humiliating or threatening way, (e.g. “With all due respect to natural childbirth, if you don’t get out of the shower now and agree to take Pitocin to speed up the labor, I will send you back to the admitting room because your labor is taking too long and we need the room for other women”). Not only can this abuse have an immediate negative effect on the labor but it can also have long-term effects on the self esteem of these women.
How many times have we all heard the comment, “The only important thing in birth is a healthy mother and a healthy baby”. Seriously? Even if it means that ONE THIRD of women will experience symptoms of post-traumatic stress disorder, potentially impacting their relationship with their spouse and baby (and possibly other children) to say nothing of their own self image? While certainly recognizing that the health of the mother and baby is of paramount importance, it is not the ONLY important thing, and right up there in priorities are the woman’s feelings of self worth and accomplishment, even if she chooses to take medication or if the baby is born by cesarean. What is often overlooked and underestimated is the fact that a woman will remember her birth experience for THE REST OF HER LIFE. She will remember not only the events of the birth, but also how she was treated and how involved she was in the decision-making process.
A big part of a quality childbirth preparation course is learning how to ask questions and to make her wishes heard in order to have the type of birth a woman wants, while maintaining harmony in the labor room. A student from one of my recent childbirth courses told me how her doctor wanted to use a vacuum as she had been pushing for a while and the baby was starting to show signs of distress. She asked the doctor if she could try pushing for another 2 contractions or if this was an emergency. The doctor said that he thought it was ok for her to push a bit longer as it was not an emergency. She then used upright positions and effective techniques and helped push the baby further down in her pelvis, before the doctor determined that he needed to use the vacuum to deliver the baby. After giving birth to a healthy baby, despite the intervention used, the woman was thrilled that she had pushed the baby down and had minimized potential harm to her pelvic floor and to the baby. She felt empowered and confident that her wishes had been heard, even though she needed to change her original birth plan according to the situation she faced in that moment.
If a woman feels positive about her birth experience, then those feelings carry over to mothering her baby and to her self esteem as a parent, even though, as we all know, those first few weeks of mothering a newborn baby are wrought with exhaustion and frustration. Why would we want to add to that already challenging situation symptoms of post-traumatic stress disorder?
I put the question of the need for taking a childbirth course over learning information about birth from the Internet to former students of mine. Yes, the population was skewed, but only women who have taken a course would know the difference. Here are some of the responses I received:
1) “Access to an expert and a live course was important for answering a lot of the ‘Why’s’. There is so much — often conflicting — information out there. The course offered a way to authoritatively sort through all the info (and pseudo-info), allowing participants to make their own informed decisions. Without it I think they’d be stuck (whether they were aware of it or not) using other people’s opinions and/or making uninformed decisions, possibly with undesirable consequences.”
2) “For me, learning about childbirth was not only about getting information but it was about the experience of coming to terms with my fears and expectations of birth through a process (group sessions, hearing from each other, and sharing our own thoughts). This is something I couldn’t get from the Internet or books and it helped me enter labor in a more calm and positive way. Having you as our professional guide helped us to navigate what is mandatory, optional, and even not recommended when it comes to birth, as well as gave us a resource to turn to for later questions leading up to the birth and after.”
3) “I found it helpful to take a birthing course mostly because of the ability that you have to ask clarifying questions. Online, and in books, people write from their own perspective. You don’t always know if it’s research-based, and you run the risk of misinterpreting what they say. It helps to have someone guide you through the process, so that you can ask clarifying questions, and understand the ‘source’ of the information better. Secondly, it’s important because you don’t necessarily know the breadth of information to ‘look up.’ A teacher can tell you about techniques, theories, and research that you, yourself, would never think to ‘google’.”
My wholehearted advice is – take a childbirth course, preferably with an independent educator (who is not restrained by the need to adhere to hospital protocol), who is able to give evidence-based information that will help you decide what type of birth is appropriate for you and will give you the tools to have that birth. Trust me, you can’t get the information you need from blogs (including this one!!!!). Take a course.
Rachelle Oseran (BA) became a Lamaze Certified Childbirth Educator in 1984 through the UCLA School of Nursing and has prepared more than 3000 couples for normal birth over the past 29 years. She is also a Birth Doula, certified by DONA International, a Fitness Professional certified by ACE (the American Council on Exercise), specializing in Prenatal and Postnatal Fitness and a Certified Yoga and Pilates Instructor. She lectures in Israel and internationally on Prenatal and Postnatal Exercise.
Rachelle teaches a Lamaze-Accredited Childbirth Educator training course. She also co-founded and co-directed Great Shape/YMCA, the group exercise department of the Jerusalem International YMCA for 23 years.
Rachelle was recently inducted as an FACCE (Fellow of the Academy of Certified Childbirth Educators) in recognition of her significant contribution to the field of childbirth education. She lives in Jerusalem, Israel, with her husband and 3 sons.