labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, July 30, 2007

Childbirth Education is a Fraud

Here is a post from Life & Times that started some talk about hospital based childbirth education. I teach hospital based childbirth ed, and therefore feel the authority to criticize it. This is one of the reasons why I started my blog childbirth ed series and be able to do it my way. For those who plan to take a childbirth education class, I highly encourage you to keep this post in mind.

Childbirth Education is a Fraud

If you attend hospital based programs, that is. This is why:
Most hospital based Childbirth Education programs have curriculum that is reviewed and approved by the medical staff. The obstetricians want to make sure that what their patients are being told is congruent with their medical management of labor and delivery. What most people don't understand is that "medical management" of labor is usually unnecessary for healthy, normal pregnancies. They want their patients to know that it is "normal" to be continuously hooked up to the fetal monitor, that an "adequate" labor pattern means contractions every two to three minutes apart even if less frequent contractions have been causing cervical change, and that epidurals are the way to go. And, oh yeah, a few minutes of breathing techniques is helpful for when you are waiting for that epidural.
I am a labor and delivery nurse in a hospital, and I teach in a hospital based childbirth education program. I am continuously frustrated by the incongruent messages that pregnant women are given in regards to "normal" birth. For most, and particularly those who attend my classes, a normal birth consists of going to a hospital, being monitored by machines, getting an epidural, and pushing on your back while your support person and the nurse hold your legs. And this may be the positive experience that most want. Which is fine if that is what makes you feel safe and what you envision as a positive birth experience. I have attended many births that follow in this path and those women and their families are very happy and grateful for the experience and outcome. So, I can't say that just one way is the right way. I have also attended births where the woman wants to grab her baby as it's being born and place their baby directly onto their chests and didn't want an epidural. But none of those things happen, and she later voices to me that she wished that she was "never talked into that epidural" and that it took 20 minutes before she even got to hold her baby after the birth.
However, what I can say is that what the public is being told is not the only way. It is also not necessarily the safest way, either. What many people don't know is the the United States does not have the lowest neonatal and maternal death rates among industrialized countries. The US has the second worst newborn death rate among all industrialized nations, according to the Save the Children foundation. Which makes me wonder how good is all of the advances in fetal monitoring really? If one was to look at this statistic: in the US, there has been a 99% decline in maternal deaths, it would be encouraging. But I still wonder what is it we are missing that other countries, such as Finland and Sweden, have figured out?
Anyhow, back to childbirth education. So as I was saying, what is taught in hospital based childbirth education programs is not what a lot of people would think of as a "normal" birth. Again, the focus on childbirth education in my class is intervention and medical management. I also cover comfort measures, but with all the other information that I have to cover in regards to what these mothers are going have happen to them when they get to the hospital cuts that material to about an hour. The total class time is 12 hours. I also try to squeeze in information about "normal" birth according to Lamaze International, and inform women of the recommendations for inductions and c-sections according to the American College of Obstetrics and Gynecology. Many are surprised to learn that what their doctors are telling them ("You're baby is probably going to be too big, so we need to do a c-section" or "You've had a lot of aches and pains this pregnancy, and I am going to be on-call the day of your due date, so why don't we schedule an induction?") are not medically or even ethically indicated. I can't tell you the number of times these things come up in my classes, and I am continuously stunned. And frustrated, because in the end, the patients almost always go with what the doctors are telling them what should be done, and I (as well as my fellow Childbirth Educators) look like liars.
One other factor is that many doctors approach their practice negatively. In other words, in our litigious society, these doctors feel they must rely on technology and conservative medical approach to birth in order to cover their butts (aka CYA). They feel it's safer to have a woman hooked up to a monitor, an automatic blood pressure cuff, and an epidural (for a quicker c-section if needed) than to allow her to walk around to facilitate labor with intermittent fetal heart rate auscultation. And so these classes must cover what the "normal" birth is like for their patients, which by my standards is not normal for healthy women.
So, the bottom line: if you are looking to learn about how to experience a "normal" birth, attend a childbirth education class that is independent of your hospital. If you can afford one, hire a doula. Or talk with a trusted female family member or friend and see if they would be willing to be your labor doula. Statistics also show that women who have continuous labor support have less complications, shorter active labor phases, and fewer medical management of pain than women who do not have a doula. Also, many women are under the false impression that their labor nurse will be at their side breathing through every contraction with them, dabbing their brows with cold cloths. As much as labor nurses want to be right at the bedside with a laboring woman, we can't. It's impossible when we are trying to manage all that equipment, interpreting fetal heart rate patterns, and also managing the care for one or two other laboring women. Which is why I wholeheartedly welcome doulas.
Anyhow, I encourage pregnant women to learn about and seek a normal birth. Because pregnancy and birth is not an illness.


Working Girl said...

Hey Labor Nurse,

I'm off next week to get my certification to teach prenatal/labor/postpartum yoga. I'm not sure where I'll teach. Until recently I taught basic yoga at a local university...
I'm curious -- do you have a certification to be a childbirth educator? I've been doing preop education during my recuperation from the broken foot and I LOVE it. Would like to spend more time teaching and maybe a little less time holding legs. I'm totally open to any advice you have. I sort of feel like the folks who teach at my hospital are very protective of their teaching slots and not so nurturing of other nurses who want to get into teaching, but maybe I'm paranoid.

How did you get started teaching? And if you are certified, how when where and at what cost?

Sorry for the super long comment. Good post!

Real said...

Thank you very much for this post. One dead link on my blog has a destination again. Five more to go!

Anonymous said...

I just hate the term normal birth (I know you didn't coin it) because it suggests there's something aberrant about the births of my two c-section children. For our circumstances, c-section was normal.

Anyway, I think your post demonstrates why hospital-led childbirth education classes are important--so that you know what your hospital's policies are before you give birth there (assuming that you have a choice in the matter).

At the hospital where I delivered, the policy is that all women get IVs in triage. Putting aside for the moment whether that policy is correct for all women, it is the policy. It creates a lot of unneeded angst if your whole birth plan hinges on your not having an IV.

I'm not saying women don't have the right to make choices about their own deliveries, but you need to choose a hospital (and a doctor) that will support you in making those choices, and a hospital-led childbirth class can help you make those decisions.

Labor Nurse said...

Working Girl, I am not certified by choice. I knew that I was not going to do childbirth ed forever so it wasn't worth the money and time to do. The only one I looked into was via Lamaze, and they require a lot of documented hours, etc. In my area none of the nurses want to teach childbirth ed so not being certified is not an issue. The CBE coordinator begs us to do classes because there isn't enough of us. However, when I asked about teaching in a large city hospital I was told I must be certified. So I guess what I am saying is if you plan on teaching childbirth ed or another patient care class for a long time, certification would be in your best interest and help give you a competitive edge on the job end.

Real, hopefully the other five will be coming along soon.

Anonymous, I think you raise some interesting thoughts and questions. You are right- some c/s births are necessary. According to WHO the c/s rates in industrialized countries should be around 10-15%...meaning that there should be less c/s than the numbers we perform. The overall US c/s rate is hovering around 30%, even higher in some areas of the country. I think the term "normal" birth is not necessarily because it is a vaginal birth but used to remind people that pregnancy and birth are not pathological processes. Unfortunately many times it is treated that way and it can lead to unnecessary interventions and operative births. When I hear the phrase "normal birth" I think of a labor that was left to follow its natural path without any intervention.

luolin said...

This post (on the first blog) was a major reason I took a Bradley class instead of the hospital class, so thanks. I'm glad I did, even though I ended up with a c-section after a couple days of labor.

I got the info about hospital policies by taking the hospital's maternity tour.

The Nurse said...

I think my hospital does an excellent job of providing education to our pregnant moms. They teach et practice relaxation, lamaze techniques, and advocate breast-feeding. We also teach about IVs, epidurals, and EFM, so our patients are informed about the process. We educate about perineal massage, et I am proud to say that rarely do our physicians cut episiotomies... the only time I have witnessed one was for a severe shoulder dystocia. We do respect their wishes for no IV, and intermittent monitoring if the hourly 15-20 minute strip is reactive... and no IV if there are no medical indications.

Autumn said...

I'm a maternal newborn nurse at a community hospital that sees around 1,000 birth a year. I also had all three of my babies there. I very quickly saw that our class wasn't so much childbirth prep as 'how to have a birth at hospital-x' however what can women in smaller communities do when there really are not reasonable alternatives for classes?

Labor Nurse said...

autumn, there are tons of resources on the web. and is a good start. If there are doulas in your area they may be able to help or know where non hospital based classes are held.

Anonymous said...

I went for a NST yesterday, and found out that the "newly remodeled" rooms in L&D look the same, new paint and art...but the monitor is now in a cabinet so mommy cannot watch it. I also found out that only two rooms have baths. Since this is my 6th born, I am interested in a bath and said to the nurse, "darn, I thought I'd get a bath when I come in." She then asked, "you planning on an epidural" I said, "no." She then said, "when you call in let us know you are wanting a bath. None of the epidural patients need it anyway, and so few women labor here without it." I have had 5 babies in the last 10 years, and it sure seems to have changed rapidly. My childbirth educator really taught me how to manage my birth and contractions...and I listened. I didn't use a focal point, nor breathing (until I was freaking out in transition and a great nurse taught me how again) but I did walk, shower, and change position. I did drink in labor (she told me to try to drink with every contraction). I imagined each contraction as a hill with a peak and then a decline down the hill. It really helped. Each birth since I've made it, no pain meds. I'm not saying no meds is for everyone, but why so many that a floor with bunches of rooms almost always has the tub rooms available? I am starting to wonder what the epidural percentage is? 70%, 90%? Hmmmm

Anonymous said...

I just started the childbirth educator certification process at a local North Texas hospital after delivering my 3 babies by midwife at Penn. Hospital. I've already been told several times to watch what I say (I haven't even said anything, I'm not teaching...). What floors me is that the OBs decided not to allow birthing balls or squat bars, and even though they are featured prominently in the childbirth book we give out we cannot mention them. It's a really weird envrionment when you come at it from trying to educate and empower women. The hospital seems to want them brainwashed.

Christina Havens Natural Mommy's said...

Labor Nurse, I love your style, you make me laugh and I love it. Great post! I had two children naturally and painlessly and I am going to begin teaching other woman how to acheive. Within this I want to include some childbirth Education as well. Can I legally teach "child birth ed" without being certified? This will only be a small part of my curriculum. Thanks in advance! Keep up the great work!:)

Christina Havens Natural Mommy's said...

Also I will NOT be speaking in hospitals.

Labor Nurse said...

christina, you do not have to be certified, but if you are planning on starting your own business it may be helpful to do so (I like Lamaze International) because some will like that you have taken the time to train under a specific curriculum, and shows dedication to the subject.

Good luck!