Monday, October 22, 2012

Updating Childbirth Education

A retrospective examination of childbearing trends shows that the natural childbirth movement of the 60’s and 70’s was successful due to the major contribution of education. 

But what has happened? Let’s take a look at the facts: 

 2012 vs 1970s 

Epidural rates are higher. 
Cesarean section rates are higher. 
“Natural” or physiologic birth rates are lower. 
Attendance at childbirth education classes is lower. 
Attendance at childbirth education classes, in some communities, is discouraged. 
US maternal/infant morbidity/mortality rates are some of the worst in the world. 

 A policy brief from The Center for Family Policy and Research of the Department of Human Development and Family Studies at the University of Missouri (Columbia) states that there are six major benefits of childbirth education classes: 

  • Enhances of woman’s confidence in her innate ability to give birth. 
  • Fosters positive feelings toward the birth, caregivers and the infant. 
  • Decreases the use of drugs during labor – including costly epidurals. 
  • Offers an opportunity for social support during pregnancy – leading to reduced lengths of labor and obstetrical complications. 
  • Facilitates positive birth outcomes, including reduction of cesarean births. 
  • Sets the stage for successful initiation of breastfeeding and adjustment to new parenthood. 

While little recent research exists, studies by Lederman in the 1970s (Lederman RP, Lederman E, Work BA et al: The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. American Journal of Obstetrics & Gynecology 132: 495, 1978) demonstrated a relationship between anxiety, maternal attitudes, plasma catecholamines, uterine contractility, length of labor and Apgar scores. Anxiety leads to an increased production of plasma epinephrine, which inhibits uterine contractility and increases length of labor. Anxiety and stress reduction are integral parts of most childbirth education class curriculum which may also include education about the anatomy and physiology of labor/birth, a myriad of comfort measures, and the importance of physical/emotional support during labor. 

What is “wrong” with childbirth education that so many benefits are not recognized by the public? Insight into this problem came from the De Vries article in 2007 (De Vries, C. & De Vries R. Childbirth Education in the 21st Century: An Immodest Proposal. Journal of Perinatal Education 2007 Fall; 16(4): 38-48.). Disconnects in childbirth education included a mismatch between what childbirth educators offered and what expectant parents wanted, cultural bias in education, and loss of community based childbirth classes (co-optation to hospital classes). If an educator is teaching the same way as in the 1970’s, then parents of today will not find their learning style with that educator. 

Educators in 2012 and beyond should examine the power of websites in education (not just pieces of static advertising), Facebook in disseminating research studies, and Twitter for sharing small but powerful bits of information. More educators should be partnering together to develop Apps for smartphones and tablets plus podcasts that can be downloaded and listened to when there is time in the busy expectant parents’ day. While some parents may be able to continue with the classroom style of education, I fear we are losing more parents by not embracing the technology at hand and trying to fit these “round” parents into our comfortable, square pegged classes.

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