Private Birth Education
Childbirth education is also called antenatal education, and its overall goals are pretty broad. The goals of childbirth education can range from increasing your self-confidence, helping you prepare for birth, helping your partner learn how to support you during birth, and helping you prepare for parenting and breastfeeding. Another common goal of childbirth education is to help you form a social support network and to meet other parents in your community who are going through the same thing.
How might we use childbirth education for pain relief during labor?
Researchers think that childbirth education might work by changing how you perceive pain during labor. In other words, decreasing the unpleasantness of pain. One thing we talk about is several different mechanisms that can act on pain, so that your brain interprets it differently or is less able to interpret it as pain.
The theory is that childbirth education acts on your central nervous system to relieve pain. We call this the Central Nervous System Control method of pain management, and basically what this means is that acquiring knowledge and skills before you give birth may activate thoughts and mental processes in your brain so that you perceive less pain or your pain feels less unpleasant during labor.
Most people think that the hospital classes will give them what they need, however researchers have found that hospital-based classes tend to serve clients with a diverse array of goals and values and that some hospital classes condition you to accept the hospital routines. Some hospital childbirth educators also sometimes feel pressure to not teach the full range of options. For those people that take a childbirth class from an independent educator who is not affiliated with a hospital, research shows that these classes tend to teach people to be critical consumers of their healthcare, and they also tend to focus on a normal birth philosophy – helping you prepare to have as normal a birth as possible.
In many hospital settings around the world, having a choice can be an illusion. This means that parents may educate themselves about their different options and their childbirth educator may encourage them to learn about these options – but if they’re entering a hospital system, where there’s a very heavy emphasis on following institutional routines and traditions, it might be very difficult for parents to access all of these options. So this means you need to make sure that you have chosen care providers and a care setting that are in alignment with your birth wishes. For example if you are wanting a natural vaginal birth with no intervention, yet you are birthing in a setting with a high caesarean rate and high induction and intervention rate, your chances of being able to navigate the birth you want will be harder.
What does the evidence say about childbirth education for pain relief during labor?
The truth is, up until this point, we have not had a lot of research evidence to guide current and future childbirth education efforts. There are very few randomized, controlled trials on childbirth education. For one reason, is it’s very difficult to conduct randomized trials on this topic. A lot of people have strong feelings one way or another about whether or not they want to take a childbirth class, and so they might not agree to be in a study where they’re randomly assigned to either have childbirth education or nothing. Some people might feel that it’s unethical to assign people to no education. Also, every childbirth class is different. There are unlimited numbers of childbirth education programs out there, all with different strengths and weaknesses.
So, one randomized trial about one educational intervention might be so different that you can’t compare it to the other classes that are being offered in your community. Also, childbirth education does not exist in a vacuum. What I mean by that is that like I said earlier, you can take a childbirth class and be educated about all your options, and be prepared to use them, but if you walk into a setting, or you have a provider who is not truly supportive of your choices, you might find yourself backed into a corner and not able to access those options that you educated yourself about.
For example, the classic studies on Lamaze childbirth classes took place in the 1970s. Even though the women were educated that episiotomies are not necessary and may be harmful, nearly all of the women in those studies had episiotomies. That’s because of something that we call the ‘Provider Effect’. In other words, if you have a provider who is not supportive of your goals and wishes, and there’s a mismatch between what you want and your provider wants, the episiotomy could happen regardless of whether or not you wanted it or consented to it. But that is a totally different topic for a different video. If you want to learn more about that topic, I would recommend Googling the words ‘Obstetric Violence’.