Childbirth Education Classes....Why do I Need Them?

Statistically, people do more research when buying a car than they do when having a baby...isn't that shocking?!  I think childbirth education (CBE) classes are the equivalent to taking Driver’s Ed when you’re a teenager: 1) You take them because you want to and should know what’s going on within the “vehicle”, 2) So that you learn how to take action to make appropriate decisions, and 3) So that you don’t have regrets after the fact if things don’t go your way.  But what type of CBE class should you take?  Where should you take them?  When should you start?  What will the classes discuss?  Do you need to take them if you already took CBE classes with a previous pregnancy or if this is your 2nd, 3rd, 10th child?  What happens if you don’t take them?  Keep reading if you want to find out…

What types of CBE classes are there?  What are the differences between them?

There are many different types of CBE classes and while they all have similarities, they have differences too.  Some of them are strictly for knowledge of the process of birth, while others get into pregnancy and postpartum.  There are classes that are better suited for those birthing outside of a hospital setting, and those where it is more tailored for hospital delivery.  Here are some of them, and a little bit about each so you know where to start in finding the one right for you:

• Bradley: This is the “husband-coached” method of helping to connect you and your partner, while giving him the tools to support you and be your advocate.
• HypnoBirthing / HypnoBabies: These methods use hypnosis and relaxation techniques to keep the mind and body calm throughout labor and birth, with a focus on relieving pain and discomfort.
• Birth Boot Camp: Focuses on natural childbirth and breastfeeding, in a contemporary manner.
• Birthing from Within: A spiritually-focused approach to birth and parenting, based on the book Birthing from Within by Pam England.
• Lamaze: This method has been around since the 1950s and has changed from just the breathing (hee-hee-hoo panting) that we all know, into a well-rounded natural childbirth course.
• Non-Specific Natural Birthing Classes: Many childbirth educators have created their own style of CBE that can be a combination of multiple methods or a creation of the educator’s own making.
• Hospital-Based Classes: These are the classes held at and usually taught by someone affiliated with the hospital (whether on staff or independently hired).  While they can have some information about natural childbirth, the majority of the class is usually about medications, procedures and an overview of the birth process.

Where should I take my CBE classes?

Many CBE classes are held at offices, birth centers, hospitals, or even in the instructor’s home.  My word of advice would be though, if you’re wanting a natural childbirth with as few interventions as possible, take a class that is not affiliated with a hospital, even if you plan to have a hospital birth.  Most of the hospital-based classes I’ve witnessed are focused less on giving you unbiased information so that you can make an informed choice, and more on teaching you on how to be a “good patient” when you arrive in labor.

When do I need to start taking CBE classes?

The answer to this really depends on what type of class you want to take.  For people interested in Bradley classes, I recommend starting in your 2nd trimester since there are more sessions in this class and you want to be done with them all before you go into labor.  If you are planning on taking a class with fewer sessions, that buys you more time before you have to get started.  Overall though, I think it’s a good idea to be taking a class soon after starting your 3rd trimester, if not before.  That way you can benefit from practicing the labor support techniques, breathing exercises, massages (who doesn’t want to have massages practiced on them?!) and relaxation exercises before going into labor.

What will my CBE class discuss?

It really depends on which class you’ll be taking.  Some will focus more heavily on labor support measures and techniques while others will be more information-driven.  All of them though should discuss the following topics (if they’re not hospital-based):

• Benefits of natural birth
• Labor support measures and techniques to help you manage discomfort or pain
• Process of labor, including early, active, pushing and immediate postpartum phases, and what to expect along the way
• When to call your care provider if you’re in labor
• Benefits/risks of medications and procedures
• Creating a birth plan
• Breastfeeding

If I took a CBE class before, do I need to take another?

I get asked this question a lot by moms who have already had another child.  The answer is, it kind of depends on you.  Has it been a long time since your last class?  Do you still remember what you learned?  Do you want to try a different type of class to learn alternative labor support techniques?  Some moms will also just take a “refresher course” with their past CBE instructor to help remind them of things they’ve forgotten or they’ll reread the text book that they received from their past class.

What happens if I don’t take a CBE class?

I’ll throw you in jail and take your sweet baby for myself!  Nah, just kidding! ;-)  Nothing happens if you don’t take a CBE class, and that is both good and bad.  You’re not out the time and expense of a class, but you’re also not reaping the benefits of one.  Moms who take CBE classes and educate themselves have a much higher likelihood of experiencing the birth that they want and feeling more satisfied about their birth outcome.  They’ll know what to expect during labor and birth, as well as things they can do to cope, and the information they’ll need in order to make informed decisions for themselves and their baby. 

In the end, yes, your baby will still be born (you won’t be pregnant for forever!).  Taking a CBE class doesn’t change that, but what it does do is to help shape how you get there.  When you’re driving on a road trip, eventually, you’ll still reach your destination, but what type of journey do you want to have?  If you have constant car trouble, get lost numerous times, or are unable to stop along the way to enjoy life’s blessings, wouldn’t it affect your overall experience and the way you look back on the memories from it? 

Interview Questions to Ask Your Care Provider

When you are interviewing your care provider (midwife, nurse-midwife, or doctor) before signing on for care (and you definitely should!), it’s difficult to know what questions to ask.  Some people worry that by asking questions, they will inadvertently offend the provider, or that they will “ask a stupid question” and be looked down upon.  I’ll tell you this right now….if your care provider is offended or treats you poorly for asking a legitimate question, they’re not the provider for you!  So how do you know what questions to ask and how to go about interviewing a care provider?  I’ll walk you through it…

When a potential client calls me, I always ask them if they would like to meet me in person before they make a decision.  An in-person interview is a great way to see if you and your provider will make a good team and if the energy is right between you.  I know that sounds hippy-dippy, but it’s true!  Everyone has an energy to them and sometimes it works well with yours and sometimes it doesn’t.  If when you’re talking with them, they’re driving you crazy and you can’t wait to leave, that’s definitely not someone you want to be working with for 9 months.

Some other things to think about, before you even start asking your questions, are: Did this person make time for you without making you feel like you were inconveniencing them?  Were they easy to get ahold of or did they return your call quickly?  Are they charging you for this interview?  Do you feel rushed to hurry up or relaxed in their presence?  Do you feel comfortable talking to this person?  Did they address you and your partner or did they leave one of you feeling left out?  These might not be deal breakers for you, but they should definitely be factors in your decision.

So once you’re actually sitting down and talking (and hopefully the care provider is receptive to your questions), here are some questions I’d recommend you asking.  While all of these questions might not apply or be important to you, they’ll help you to figure out if your provider is supportive of natural childbirth and give you an idea of what you can expect with them…

Overall Questions:

• What is your philosophy regarding pregnancy and childbirth?
• What made you decide to become a midwife/nurse-midwife/doctor?
• What were your births or the births of your children like?
• How many clients/patients do you take on a monthly basis? 
• Will you be on vacation near my due date (especially important if you are due near a major holiday)?
• If I have a problem and it is after office hours, or on a weekend, how can I get ahold of you?
• Would you consider me to be a “higher risk” client/patient because of a certain condition/status? (ex: being age 35 or greater, having had 4 or more prior babies, history of miscarriage, past cesarean section delivery, BMI of 30 or more, etc)
• Can you provide me with letters of reference or contact information for past clients/patients (with their consent, of course) who could talk to me more about what it was like being a client/patient of yours?

Pregnancy Questions:

• What tests/procedures during pregnancy and birth are mandatory?  Which are optional?
• How long will I get to spend with you personally during each of my prenatal appointments?
• What does a typical prenatal visit look like?
• Can I bring my children to my appointments?  Can they be involved in my care (helping to measure belly, holding Doppler to listen to heart beat, etc)?

Birth Questions:

• How many of your clients/patients who intended to birth without pain medications actually go on to do so?
• What is your cesarean section rate?  Episiotomy rate? 
• What percentage of your clients/patients end up having perineal tearing that needs to be repaired?
• Do you routinely do delayed cord clamping?
• How long can my baby and I be skin-to-skin after birth without interruption?
• For what reasons would you ever want to induce my labor?  How far past my due-date can I be before you’ll want to induce?
• Can I eat and drink during labor?  Have freedom of movement? 
• How do you feel about intermittent fetal monitoring in labor?
• Do I have to have an IV during labor?
• Who will you have present for my birth (assistant, nurse, student, etc)? 
• Will you be present at my birth or do you work with others who might ever be there instead of you?
• Can I have anyone I want present to support me in labor or am I limited to who or how many people can be present?
• Can I have pictures taken of my labor and birth?
• What do you think of “birth plans”?

For Out-of-Hospital Midwives Only:

• What is your personal transport rate of clients who ended up at the hospital?  (not the statistical rate for across the country averages)  What were some of the causes for these transports?
• Who is your collaborating physician and what is his/her view of natural childbirth and midwives?
• What is your protocol in case you have 2 clients in labor at the same time?
• At what point will you transport me for an induction of labor?
• How do you feel about water birth?  Do your clients have many water births?

While it might seem like these are a lot of questions to be asking, I can assure you, they’re all important.  Your provider’s answers to these questions (both how they answer it and the answer itself) will help you to determine if they are the right fit for you.  You wouldn’t hire a nanny, general contractor, or employee without questioning them thoroughly, so why does our society view this any differently?  The person you choose could mean the difference between you having the birth you desire and every intervention imaginable.  You are PAYING this person for a service!  You are the customer!  Don’t settle!!!  If you've already signed on with someone when you discover they're not the right fit for you, don't be afraid to switch providers!  Sometimes the only thing that makes a pregnancy high-risk or keeps it from being everything you want, is your choice of care provider.