I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.
Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.
What’s on the docket for Week 2?
I challenge all pregnant persons to sign up for an independently run childbirth education class.
Ever heard of tocophobia? It’s a term used to describe the fear of childbirth. Researchers in Sweden have found that when expectant fathers experience tocophobia, it may have negative effects on the birth experiences of their partners, particularly male partners.
The study, titled Psychoprophylaxis - Antenatal preparation and actual use during labour, by Malin Bergström found that many of these men were fearful not only of the process of childbirth, but in their roles as parents as well. There have been some signs to indicate that tocophobia contributed to an increase in cesarean sections, pointing to the need for birth professionals to address these fears with expecting parents.
The since the study, the Swedish Medical University has begun providing childbirth preparation classes featuring the use of psychoprophylaxis (relaxation techniques) for all expectant parents with good results.
Unfortunately, only 30% of expectant parents in the U.S. take any sort of childbirth education, the majority of those taking the shorter and more restricted classes taught in the hospitals.
Independent childbirth educators encourage both mother and partner to participate in class discussions to try and address these common fears about labor and early parenting. Educational models such as the Bradley Method, Hypnobirthing, and Birthing from Within place a great deal of emphasis on the partner as a strong yet calm source of strength for the woman in labor by teaching the partner relaxation techniques like massage and affirmations.
In another study on childbirth education classes from Lamaze International* the researchers discovered the rate of attendance for childbirth ed courses, and particularly courses lasting more than one session, has been decreasing over the past several years. Couples are encouraged to take lengthier courses, independent of the hospital preparation courses to get a more complete training in birth support.
Additionally, hiring a doula can help parents receive one-on-one training in these techniques and a sense of security in asking questions concerning any anxieties in an intimate and supportive setting. Doulas also help the partner to feel comfortable that everything is going well in labor, knowing that the mother will never be left alone and that there is a constant source of guidance and expertise by their side.
Unfortunately, the way the American medical system is set up, there is so little time afforded to any one patient/client at a time. How is it possible to fully go over all of the major changes of pregnancy, build trust, talk about preventative care, go over routine tests and if they’re necessary, talk about a birth plan, talk about what to expect, discuss routine newborn care, teach someone about breastfeeding, go over partner involvement, discuss family planning options, and touch on the politics of informed consent and refusal in a 7-10 minute visit with an OB (that’s the national average)? It’s impossible!
This is the reason why the majority of women in the U.S. get their prenatal education from books and online articles. While that sounds innocuous enough, the unfortunate truth is that there’s a lot of garbage out there and unless you are an expert in birth, it might be hard to figure that out. Take for example, the horrible What to Expect series, which is sometimes dubbed “What to Expect When You Expect Everything to Go Wrong,” which is not written by birth experts at all and is full of factual errors. Or the even more offensive, “Girlfriends Guide to Pregnancy,” which is so horrible I don’t even want to waste my breath on explaining how.
There is inherent bias in all of these guides–there is clear bias even in my reviews of them above, obviously. The point is whether or not you can see the bias, and then having the tools and feeling empowered enough to take it or leave it. It’s scary to do that when you have your life and the life of your baby at stake, but truly, birth is primarily a safe and normal process, which doesn’t need a whole lot of bells or whistles (or surgery, for that matter), and going with your gut and getting the birth you feel is right for you and baby really is the only important bias to consider.
Talking about the politics around pregnancy and birth is not the fun, gooey, warm stuff most people want out of a course on natural childbirth. I’m fully aware of that. However, after attending births in almost 20 different settings, in 4 states and abroad, I can tell you that many of these topics related to the political aspect of birth are way more essential to understand than a mantra or supported squat. Those sorts of amazing “natural birth” things actually happen on their own because we’re biologically programmed to do them, but they can only happen if you are in a supportive environment where you feel safe and empowered.
Another great reason to take an independent childbirth education course: Understanding the principles of informed consent and informed refusal.
Some basic principles of evidence-based health care are:
Question common assumptions. Be skeptical! Many widely held beliefs about health care do not reflect the best available research. This may lead to poor care and health outcomes. Don’t hesitate to say: show me the evidence.
Consider the best studies. Quite a few studies are poorly done, and many have weak designs. Poorer quality studies should not be used to guide decisions. When a new study is reported, we should ask: what is already known about this question on the basis of the best available research, and what, if anything, does this study add?
Look for the “Gold Standard.” When available, well-conducted systematic reviews of research should inform care decisions. If systematic reviews are not available, individual studies with randomized controlled trial designs can provide a good alternative. It may be important to consider other types of studies as well. (See more about systematic reviews and randomized controlled trials below.)
Make informed decisions. When making decisions about your care, it is important to consider the best available evidence in combination with your values, preferences and circumstances. Also, take into account care setting issues, such as the skills of caregivers and available forms of care.
Informed consent is rarely a topic discussed in the classes taught in the hospitals themselves, for somewhat obvious reasons. The deferred starting point of medical decision making is doctor-centered, not parent-centered, so why discuss an alternative in the preparation courses?
One class I highly recommend, both for it’s discussion of informed consent as well as a deep dive into the important emotional preparation for labor is Rachel Yellin’s YES to Birth, which you can take in person and online.
From her site:
Using hypnosis, relaxation, meditation, breathing, the power of your mind, and the connection with your baby to give birth the way that nature intended.
Classes are appropriate for pregnant women who either know that they want a natural birth or who want to try for the most natural birth possible. Hospital, home birth or birth center birthers are all encouraged to attend.
Rachel offers private classes and one-on-one depth hypnosis sessions to prepare you for labor, as well. You can also download all of her guided meditation tracks on the site, which are a HUGE help in childbirth and beyond. Folks I’ve worked with who have taken Rachel’s classes and/or used her guided meditation in pregnancy and birth have felt more confident in their ability to advocate for themselves in labor as well as feeling safe and satisfied with the laboring process. Their partners feel well prepared to be the primary support persons and all report feeling so grateful they took such an honest and in-depth class. It’s well worth the time commitment, I promise! You can use the code “ebd” at checkout for a discount on downloads and “25BUCKSOFF” with my name (Emily Flynn) to get $25 off any classes you register for online or in person.