Tuesday, November 09, 2010

Risky Business ~ 27 Years of Coopted Childbirth Education

When Eugene DeClercq wrote in the fall of 1983 in the Birth Journal,  "The Politics of Co-optation: Strategies for Childbirth Educators", I was riveted to my seat as I read.  This man seemed to have a direct vision to the future.

Now, 27 years later, I am convinced that he did.

That tragedy of co-optation has come true.  First seen as a marketing gold mine, hospitals jumped on the childbirth education providing wagon with unimaginative speed.  Some chose to have their nurses obtain certification by childbirth organizations, while some handed the labor/delivery nurses a script (not even a curriculum) with exactly what should be said.  Others hired certified educators specifically for the task ~ in some communities these educators where nurses.  In others, the only requirement was childbirth education certification.  Add to the low cost of hospital based childbirth classes free car seats and steak dinners (popular in the 1980s), and why would anyone register for a childbirth class taught by an independent or community educator who charged more and offered less?

You do not have to be a nurse to be a great childbirth educator.
Many nurses are not good childbirth educators.
Nursing schools do not prepare you to educate.

As the decades rolled by, the essence of prepared childbirth ~ education, relaxation and happier/healthier moms and babies began to wane.  Intervention rates rose as did the maternal/infant morbidity rates nationwide.

Some hospitals put pressure on childbirth education departments to keep their revenue high and their budgets in the profit margin, while watering down the curriculum to appease those that have a final say over what is said in the classes.  In many hospitals, those people are the physicians.  To counter this, some childbirth education managers together with their educators, created binders with topics covered in class and the documentation/evidence based research that substantiated what was said…often from obstetrical journals.

Am I totally against hospital-based childbirth education classes?  The answer is an emphatic NO.  I have taught childbirth education for many hospitals à those that espouse to teach childbirth education from the risk/benefits point of view and whose managers are not afraid to back their educators when the educators teach evidence-based, current information.  Yes, those hospitals do exist!

Colateral damage to this co-optation tale are the alarming number of press releases lately of hospitals discontinuing classes or downsizing or retooling their childbirth education departments.  Guess what?  Childbirth education classes are not money makers.  Who knew?

The victims of this economic conundrum are not only the expectant parents who lose the option of convenient childbirth education classes, but also the newborns who may suffer the consequences of domino effect of lack of education.

As Linda J. Smith said in her book Impact of Birthing Practices on Breastfeeding:

“Solid scientific evidence shows that minimizing interventions in birth and policies that preserve normalcy are associated with faster, easier births; healthier, more active and alert mothers and newborns; and mother-baby pairs physiologically optimally ready to breastfeed.  In addition to the quantifiable evidence is the cumulative wisdom of women who know that normal childbirth and breastfeeding go together.”

The time has come for a resurgence in independent and community based childbirth education.  As when I began teaching in 1979, the road is not a smooth one and if you decide this is a road for you to follow, be prepared to work hard, market hard, and don’t be boring. You don’t have to have flashy charts, an expensive pelvis, or costly videos.  I began with homemade charts & handouts (hand drawn as there were no computers), a knitted uterus and a doll from the local toy store.  Parents learned.  Parents were educated.  And mothers surged through labor and birth with a sense of empowerment, being in control and preserving the sacred space for birth.

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