Before I start, a small disclaimer: I started my career as a childbirth educator, and continued to teach in hospitals until 2 years ago. I was honored to teach with some amazing educators, and I do know there are still a handful of programs in Minnesota (and by a handful, I mean 5) where the classes are taught, for the most part, by caring, qualified childbirth educators and nurses who truly have a passion for teaching and are willing to stand up for evidence-based curriculum. However, they are the overwhelming exception, and not the rule. So before I go any further, I want to acknowledge the educators and program directors who still believe in providing quality classes to parents in hospital settings. You women rock.
Teaching in a hospital can be a tricky proposition. Even the best-run programs face various pressures from many sides that all have an effect on the quality of classes. The realities of maternity care in the US are coming together to create a difficult climate for evidence-based prenatal education. Sadly, attendance in childbirth classes has dropped dramatically in the last 15 years, and I’m sure bad classes are part of the issue. So, while you might think the best choice for prenatal education for a hospital birth is to attend the hospital-sanctioned childbirth classes, here are some reasons you need to think again:
1) The classes are just too big
I find it shocking to hear how many people who go to attend childbirth classes sanctioned by their hospital do so in an auditorium or in a room with 15-20+ other families. Lamaze limits the number of families that can attend a Lamaze series to 12 for a very good reason: big classes make it impossible to have a positive, interactive class that allows enough time for classes. Also? Classes that big are run in lecture format, and that’s just boring.
2) Information is restricted
Even when I taught for wonderful programs, it was inevitable: Certain topics are off-limits, despite the fact that there might be piles of evidence and official policy statements to back up the information. In the best cases, small facts might be forbidden. More often, though, entire topics are left out of the curriculum. Like what? Well, anesthesiologists might not allow educators to talk about the risks to an epidural, OBs might not want VBACs mentioned, or educators might not be allowed to even discuss Cytotec or Cervadil. When waterbirth is offered at a hospital but not all practitioners support it, educators might not be allowed to discuss waterbirth, lest the glaring differences in personal practice styles come to light. To help with conformity, you’ll find that:
3) Classes are nothing more than a bunch of Power Point slides and videos
As Chief OBs, program directors, company owners, and hospital administration have increasingly wanted to increase their strict control over class content, power points have become the preferred tool to make sure educators don’t stray from party line. It’s also the best way to cram a HUGE amount of information in a ridiculously small amount of time. Want to fit everything about pregnancy, labor, birth, and postpartum into 4 hours? To do this you MUST just sit families down, start up the slides, and start reading to them, and not allow time for interaction. No wonder so many people think childbirth classes are worthless. You don’t need to pay someone to read to you.
4) Opinions trump evidence
Again, most of my colleagues at the hospitals I taught at really wanted to provide information to parents so the parents could make their own choices. However, I did have colleagues who were L&D nurses who only were interested in telling moms how to be compliant patients. Their goal was getting moms ready to be an easy, perfect patient. (Honestly, I’ve seen independent classes that have the goal of compliance as an undercurrent, as well. Those classes are bad, too.) Instead of telling moms about options, mothers are simply told what they will do when they give birth. And, as overwhelming evidence is showing, routine protocols that involve high rates of interventions end up with worse outcomes for mother and baby.
5) The Fear Factor
First, there needs to be a distinction made between explaining the risks versus benefits of a procedure and flat out trying to make parents fearful. I’ve sat in on classes as colleagues have spent 10 minutes recounting the horrors of cord prolapses in excruciating detail. I’ve heard them describe unmedicated vaginal births in such colorful terms it would even make me want twilight sleep. And this commentary published last year by a local radio reporter is stunningly depressing. But fear is a motivator, but also highly manipulative. (Although, I do know some childbirth methods use fear-mongering to convince mothers to have unmedicated births too, but that that’s another post for another day.)
As I was working on this post, a mother who had taken both our classes AND her hospital’s classes commented on a Facebook post of ours. Any mom who has taken both sees a difference, but her quote is perfect:
I’m so glad we took our classes at BabyLove. We also took one at the hospital, and let’s just say they told us a whole different story. Because of the classes we took with BabyLove, we were empowered and knew that we could have a completely natural complication-free birth (and did).
Again, there are still some good hospital classes around, but it’s time that we all realize that the majority of hospital classes (both run in-house and contracted out) are a waste of time at best and damaging at worst. No matter what families desire, at the end of the day, we at BabyLove believe that every family deserves to have prenatal education that is evidence-based, can speak to a variety of choices, positive, and encouraging.