When you choose your caregiver and the place where you will give birth, you will have made the two choices that most affect your birth experience. Besides those, however, other choices also make a big difference. For example, your choice of childbirth classes will influence your feelings of confidence and readiness as you approach the birth and early parenthood.
The idea of formal classes to prepare women and their partners for childbirth came to North America in the early 1950s when the work of Grantly Dick-Read, an English obstetrician, became publicized. Dick-Read was the real pioneer of natural childbirth techniques in the Western world. As a young physician in the 1930s, he presented a new approach to childbirth management. He used education, relaxation, slow abdominal breathing, and caring labor support to combat the three-way cycle of fear, tension, and pain that fed on itself and escalated during labor to the point where a woman had to be heavily medicated. His belief that much of the pain women experience during childbirth is unnatural and unnecessary guided him in the development of the Dick-Read method.
In France in the 1940s and 1950s, Dr. Fernand Lamaze developed another, quite different, system of childbirth preparation, which was widely practiced in France and later in North America. Lamaze called his method psychoprophylaxis -- literally, mental prevention. He emphasized complex distraction methods and the dominant role of a professional coach to reduce a laboring woman's awareness of pain. Though these methods have differences, they share the belief that if a woman receives instruction on anatomy and the physiology of the birthing process, she will be less fearful and better able to participate in and facilitate the process.
Some competition and rivalry has always existed among proponents of the Dick-Read and Lamaze methods. Yet both methods thrived because they appeared at a time in our history when many women were heavily drugged and unconscious through labor and delivery. These methods of natural childbirth appealed to women who wished to be more in control during labor.
Childbirth education has evolved over the years, with major modifications contributed by prominent childbirth educators and obstetricians. Among them is Robert Bradley, the American obstetrician who brought the father into the birth situation as a labor coach. Fathers had traditionally been prohibited from attending births, but Dr. Bradley felt not only that the father's presence was his right, but also that his role as labor coach was an appropriate one for him to play, helping his partner through the labor process.
Sheila Kitzinger, a well-known British anthropologist and childbirth educator, brought a woman's perspective to childbirth preparation, emphasizing body awareness, innovative relaxation techniques, and breathing patterns that harmonize with the intensity of a woman's contractions. Rather than distracting the woman from her labor pain, Ms. Kitzinger said that labor pain is nothing to fear; it is "pain with a purpose." By accepting her pain and working with it, a woman can cope successfully and reap great psychological rewards from her active participation.
The popularity of natural childbirth led to the founding of several national and international organizations devoted to promoting family-centered maternity care, parent participation in childbirth, and childbirth education classes. The International Childbirth Education Association (ICEA), Lamaze International (formerly known as the American Society for Psychoprophylaxis in Obstetrics), and the American Academy of Husband-Coached Childbirth (AAHCC) were founded in the early 1960s to give parents a greater voice in maternity care. A closely related issue, the promotion of breast-feeding, became the cause of La Leche League International (LLLI), also founded in the early 1960s. These organizations and others contributed to effective change in maternity care in favor of more consumer involvement and choice.
In the 1970s, Dr. Frederic Leboyer drew our attention to the newborn baby and what he or she goes through during the birth process. He promoted "birth without violence," or gentle birth. He said that the baby should be helped to a gentle and calm transition from life in the uterus to life outside the mother's body. He advocated a warm, quiet room with dim lights for the birth and a warm bath for the baby shortly after birth.
Also during the 1970s, the term bonding was coined after it was discovered that when newborn babies stayed with their mothers for extended periods of time, the behavior of the mothers seemed to be more loving and maternal than that of mothers whose babies spent most of the time in the nursery. The work of Leboyer and others focused the attention of parents and caregivers on the early care of the newborn and early interaction between parents and newborns.
In the 1980s, investigators with training in psychotherapy focused on the healing potential (and, conversely, the potential for emotional trauma) of the profound experience of childbirth, and incorporated counseling and stress reduction measures into childbirth preparation. Some have urged more spontaneity in childbirth and less emphasis on intellectual preparation and prescribed responses to labor contractions. Childbirth education continues to evolve as we learn more, as people's tastes change, and as maternity care changes.
Finding the right childbirth class may require you to do some comparison shopping. Some classes teach only one method (Lamaze or Bradley, for example). Others provide a broader, more individualized kind of preparation, drawing from these methods and the other innovations to provide a framework of relaxation techniques, patterned breathing, massage, visualization, music, sound, and other pain-reduction methods, along with guidelines for adapting them to suit the individual.
The goal of these classes is to enable women and their partners to discover their own style for labor.
Many communities have independent, consumer-based childbirth education groups that provide classes. Most hospitals and some groups of physicians or midwives also sponsor childbirth classes for their patients or clients.
Where to Start
You can begin the search for classes by asking your caregiver, your friends with babies, or the hospital's maternity department for suggestions. Then call and ask the sponsors of childbirth education to describe their classes.
- Find out who the teachers are. Ask if it is possible to interview the teacher before registering in a class. You can learn a lot in a brief phone conversation. Is the teacher an independent certified childbirth educator who subcontracts her services? Or is she an employee of a hospital or group? Does she belong to one or more of the local and national organizations of childbirth educators?
- Ask about the teacher's qualifications. Some sponsors require a medical background, such as nursing or physical therapy. Others require a college degree, sometimes in a related field, such as psychology, social work, education, or biology. Some have no specific educational requirements. Many sponsors require that their teachers have a child. In addition to background requirements, most teachers have received training in childbirth education. Training may be minimal (for example, the teacher may be required only to observe a series of classes) or it may be rigorous. Certification by one of the national or international childbirth education organizations may be required. Some community childbirth education organizations provide their own training and require their own certification. The certification process may include classroom sessions or workshops, written work, examinations, observations of childbirth classes, attendance at births, and teaching under supervision.
- Find out the number of classes in a series. They range from about 4 weekly classes to as many as 12. Classes may last 11/2 to 21/2 hours.
- Ask what topics are covered. Possible topics include self-care in pregnancy, preparation for normal and complicated childbirth, cesarean birth, newborn care, breast-feeding and bottle-feeding, and the beginnings of parenthood. You should know how much time is spent on learning and practicing techniques for coping with labor, such as relaxation, breathing patterns, massage techniques, and methods of visualization and focus.
- Ask about class size. Classes may range in size from private sessions for one or two couples to very large classes for 40 to 50 couples. A small, intimate class may be important to you, or you may prefer a more diverse, larger group. If the group is large, does the teacher have one or more assistants to provide more personal contact with the students? Is there room for everyone on the floor? Is personal contact by phone or private consultation available if you wish it?
- Find out if there is a reunion of the group after the babies have been born. If so, it indicates that the teacher is aware of the importance of group support. It also shows that the teacher has an interest in following up on her students.
Many communities offer specialized classes, such as the following: early pregnancy classes; home-birth classes; refresher classes (a shortened series for those who had childbirth classes during a previous pregnancy); cesarean preparation classes; classes for single mothers, lesbians, parents with a language barrier, parents with impaired hearing or vision, and teen parents; classes for women planning to give up their babies for adoption; classes on vaginal birth after a previous cesarean; sibling preparation classes for other children in the family; grandparent classes; adoptive parent classes; and breast-feeding classes. Postpartum classes for parents with their infants are also offered in many communities.
The final step to prepare of childbirth is coming up with a birth plan. Go to the next page to find out about all the preparations you need to make for your child's arrival.