Before giving up on natural childbirth classes, childbirth educators should take the time to read the new BJOG study which concludes that learning natural childbirth “techniques” does not decrease epidural use or cesarean surgery rates. There is much to think about from this provocative study. The study is a randomized, controlled trial. This means that the women (and their partners) in the study agreed to be randomized into classes that either included natural childbirth information or into classes that did not. Of the 1300 women who were eligible for the study, 213 or 16% declined to participate in the study. Women who don’t mind attending classes that do not cover natural childbirth may not be very interested to begin with in natural childbirth. Indeed, the authors of the study acknowledge that prior to randomization, more women and men in the “Natural” group had a positive attitude toward epidural analgesia than women in the “Standard group”; and more women in the “Standard” group had a positive attitude towards psychoprophylaxis during labor than women in the “Natural group.” Both the “Natural” and “Standard” groups attended four two-hour childbirth education classes. The “Natural” classes included 30 minutes of practicing natural childbirth “techniques” in each class and very little postpartum/parenting information other than a little bit of information on breastfeeding. The “Standard” classes did not include any information on natural childbirth “techniques,” but did include information about transition to parenthood, parental relationships, ATTACHMENT, and baby care. Very little information about teaching strategies is included in the BJOG article.
Labor is challenging, hard work. In most cases, a woman has to want to experience natural childbirth in order to do so. A woman’s desire for natural childbirth is shaped by many factors in addition to what she learns in childbirth classes including the attitude of her health care provider, the birthing environment, attitudes of friends and family, what she sees in popular media, and previous experiences of dealing with pain.
Childbirth educators in recent years have come to realize that, if their goal is to promote normal, natural birth, it is not enough to just have students practice natural childbirth “techniques.” Adequate time must be spent in addressing fears and in presenting the “simple” story of physiological childbirth as described by Lothian and DeVries in The Official Lamaze Guide. Labor, birth, early attachment, and breastfeeding are all critical components of the childbirth experience. What happens during labor and birth does affect early attachment and breastfeeding. Routine interventions that interrupt or disturb the hormonal orchestration of labor, birth, and early postpartum can negatively affect early attachment and breastfeeding. In order to present a complete picture of normal, natural birth, childbirth educators must include attachment in their classes. For women who want to experience a natural birth, relaxation and breathing strategies can be valuable coping measures. But the childbirth educator must also spend time helping the pregnant woman and her partner to plan for a support team that will provide encouragement and not promote or use unnecessary medical interventions and for an environment that encourages upright positions and movements and nonpharmacologic comfort measures such as birthing tubs.
I do not believe that one can conclude from this study that natural childbirth “techniques” are not valuable. Instead, one might ask, “Do we have a culture in which normal, natural childbirth is viewed as the optimal approach to birth? If not, why not? What can we do as educators to not only help women learn strategies that will promote comfort and progress in labor, but also to view labor and birth as the normal physiological process that it most often is? And to believe that the hard work and challenges of natural birth are worth the effort for the benefits to their babies and to themselves.