Cutting class? (Sara Krulwich/The New York Times) Pregnant women are cutting childbirth class.
Although women are more obsessed than ever with health during their pregnancies, they seem to have lost interest in learning about the end of pregnancy, also known as childbirth, reports the November issue of Fit Pregnancy magazine.
“Fewer women are taking classes,” said Jeannette Crenshaw, president of Lamaze International. Ms. Crenshaw told the magazine that she believes several issues explain why women aren’t as interested in learning about childbirth. Many women, she says, are convinced they can’t deliver a baby without epidural pain relief. Television shows often depict birth as a dangerous event, even though serious problems are exceedingly rare among women delivering in the United States. And because many women work until nearly the last day of pregnancy, busy schedules often prevent them from scheduling a birthing class.
Marjie Hathaway, co-director of the American Academy of Husband-Coached Childbirth, which teaches what’s known as the Bradley Method of natural childbirth, also told the magazine that interest in childbirth classes has waned. “Today, women are more focused on prenatal testing and monitoring the pregnancy than in learning how to give birth,” she said.
Research shows that there’s no real difference in pain, labor interventions or birth outcomes among women who take childbirth classes and those who don’t, the magazine reports. The classes appear to attract women who are the most vigilant about their health during pregnancy. Women who enroll in a childbirth class are more likely to have quit smoking, keep prenatal appointments and to breastfeed after birth, the magazine notes.
Childbirth education started in the 1940s, after a British obstetrician published the book “Childbirth Without Fear,” advocating relaxation techniques to ease pain and fear during labor. French obstetrician Dr. Fernand Lamaze developed focused breathing techniques to help with the pain of childbirth.
But today hospital-based classes tend to focus more on a tour of hospital facilities rather than techniques to cope with labor pain. The magazine argues that women’s declining interest in childbirth classes is worrisome because it’s happening even as childbirth has become more “medicalized” than ever. During childbirth, a number of variables can arise and women have to make informed decisions about procedures like epidurals, episiotomies, induction and C-sections. “That’s where you reap the dividends of having had a teacher who explained each possible intervention and showed you how to be your advocate,” the magazine reports.
The Fit Pregnancy Web site offers several descriptions of the different types of childbirth classes as well as contact info to find a class.
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From 1 to 25 of 264 Comments
We have three children and my oldest is 10. We took a Lamaze class 11 years ago. I think the class is more important for the father than for the mother. My husband was so scared and intimitated about the childbirth before the classe. The class gave him the confidence he needed so that we both were able to celebrate our child’s delivery.
— Lena ZafiriadesWhat a blessing for guys!!!
While totally crazy about my kids, would have much preferred skipping the Lamaze courses and being in the delivery room. Childbirth with the daddy present is a bad idea. Wracked with pain and lying exposed to everyone our ladies aren’t thinking loving thoughts looking at us!
— MARK KLEIN, M.D.I am a childbirth educator and Doula in San Francisco, CA and the news that fewer women are educating themselves IS news to me. My students and my clients most often come to me eager to learn about both the process of giving birth and the much longer process of parenting that follows.
I teach not at a hospital, but at an independent parenting resource center. My students learn about the physiology of labor and about the many, many comfort measures they can use to manage the pain of labor. Myself and the other educators do not hold to one single method of teaching, but rather touch on many - Lamaze (breathing and focus), partner-centered (lots of practice together), hypnobirthing (visualization and guided relaxation), and more.
We do feel that our students have births that differ in a number of ways from those who do not spend time educating themselves. The most important is that they practice informed choice. They ask questions. They feel empowered by the knowledge they do hold. In the face of medical emergency, which happens very rarely, they know to let the medical care providers run the show, but other than that, the parents understand that birth is a normal and healthy process, something that has been going on with great success for millions of years. The stories I hear from them are filled with wonder at the work involved in giving birth, but also at the partnerships they formed with each other and the awe they felt when their babies were born. They pay attention to what is a natural function of life, they stay mindful, and whether or not drugs are used (which they are, but on a much lower scale than the average) or cesarean sections necessary, they remain committed to the scientific fact that birth is a normal process.
— Amy HyamsAs it turns out, babies manage to be born whether you are breathing Lamaze-style or in whatever manner feels best to you. Childbirth classes are a nice way for people to scam money out of worried pregnant mothers; in the end, being born is the baby’s job, and the baby doesn’t pay attention during class.
— PatrickIf the outcomes are the same between the women who take classes and those who don’t, and since there is no medal given out for being in pain for seven hours, why exactly would women have to take classes or not get epidurals? It is up to the woman and her physician to decide what the best course of action is and implying that it’s the women who take better care of themselves are the ones who have natural childbirth is very insulting. I quit smoking the day I found out I was pregnant, never missed a doctor’s appointment, took the vitamins and did everything in my power to have a healthy pregnancy. I still got an epidural. That makes me a bad mother, all of a sudden? Was this written by a man?!
— LidijaTPP responds: It was written by a woman and a mother of one. I don’t think this was a judgmental story at all — it just made the point that women were skipping birthing classes, which I find to be an interesting trend. The story noted that the classes tend to attract the type of women who are super-vigilant about their health during pregnancy. The only downside that I see is that some women who aren’t interested in learning breathing techniques may be missing out on some other useful information taught at these classes. Personally, I wasn’t interested in the breathing either, but my doctor forced me to take the class. I found a lot of it boring, but my teacher also shared some useful information about the hospital process I wouldn’t have heard about otherwise. tpp
As both a past Birth nurse (25years) and childbirth educator (30 years and continuing) I find this mind boggling in general; but even more so in this time when a number of young families in the city of Indianapolis Indiana where I have retired are struggling for rights and control in a subculture of birthing that is repressively medieval. A grass roots cry has produced a response to this need in form a a web site http://www.henryjude.5u.com which to the best of my knowledge has not been given any media coverage in spite of my best efforts. The educational interactive site still gets over 10 hits a day just by word of mouth. So clearly while some childbearing age families are hungering for knowledge to control their birthing proces, others are dieting to political anorexia.
— Henry Jude Karwowski BSRNI can’t believe all the whining! The reason I’m not interested in taking a class are these: a. All the information about various birthing methods or pregnancy complications is freely available on the internet, should I ever want to read about it. I don’t need to pay 100 bucks to be retold the same information by a class instructor at 9 a.m. on a weekend morning. b. There is nothing wrong with planning on an early epidural (currently approved by ACOG). Not everyone is interested in a natural childbirth, and thanks to the advances in medicine, epidurals are safer and better than ever. Thanks to one, I had a completely painless uncomplicated labor with my first child, and hope my second labor will go the same way.
— IreneI feel, in general, women are much better informed about the whole process, and very knowledgeable about pregnancy and childbirth than they ever were. The reason why they’re choosing not to take childbirth classes probably has to do with a fact that these classes fail to fulfill their needs, not because they are not interested in childbirth. With this second pregnancy, I really don’t see what kind of benefit I will get out of any of these classes. I will just ask the hospital for a quick tour of the L&D unit.
“During childbirth, a number of variables can arise and women have to make informed decisions about procedures like epidurals, episiotomies, induction and C-sections.”
We had our first child in the hospital naturally. The biggest challenge turned out to be simply insisting on the childbirth we’d planned and prepared for.
We did take classes at a local mid-wifing center but they were not focused on a certain technique or method of childbirth. They were more informational, and got us in contact with others going through the same thing. We heard other family’s birth stories and talked about our questions and fears. Having someone there to answer those questions or point us in the right direction to have them answered was invaluable in my opinion. I couldn’t recommend this more highly.
— Andre DelenaWow! What a shame! But I’m not surprised. I am a nurse who sees more and more a dependency on outside forces to overule the individuals abiltiy to adapt and cope. And the insistent fear of any kind of pain. Give me drugs and YOU take care of it is the frequent appeal.
For myself, learning how to breathe and deal with intense physical pain of labor, and being in a position where I believed this was MY event, not the hospitals/doctors was very important in the relationship with both my children (now grown) and with the physical changes of growing older. Childbirth is a lifechanging event in so many ways. . . . .it’s sad that women would rush through, or miss the enormous benefits to being educated and in charge, thinking that their “job” which is always temporary and entirely replaceable, is somehow more compelling. I don’t want to make generalizations here, but the handing over of one’s body to the medical establishment and ignoring the education available, seems part of the trend of then handing over one’s precious children to a competitive, dysfunctional education system. Women, wake up!!!
— Virginia EllisWomen have found that they could spend hours of education and training with a birthing instructor with specific goals of avoiding an episiotomy or pain medication only to have the delivering physician over rule the mother’s birthing plan, whether legitimately or not. With the “we know what’s best for you” attitude from medical staff, a woman might be hooked to an IV with internal or external fetal monitoring none of which encourages walking, warm showers or major position changes in the process of labor. Why waste time taking classes trying to control a process that’s out of your control?
— VI think women are taking fewer childbirth classes because they are relying more on their doctors and their own research for concrete information. I gave birth to my only child at 40 with a walking epidural. This was an option I chose for myself with the support of my doctor.
I have four sisters (one a former Lamaze teacher) who have given birth to 13 children naturally and three by cesarean so I’m intimately familiar with the other options.
I found the childbirth class at my local birthing center completely irrelevant - the teacher focused entirely on natural childbirth and offered her own, unsolicited advice about parenting and marriage circa 1970. She even suggested that women in childbirth have only secondary access to the hospital’s anesthesiologist! Something my doctor told me later was completely untrue.
— janeThe problem is that most birthing teachers live in this little perfect world where everything goes according to plan, birth is always a joyous and simple event, and breastfeeding is always possible for every woman, no exceptions - unless, of course, the mother is lazy and doesn’t try hard enough. They berate and ridicule women who make different choices and guilt and intimidate mothers into choosing the “natural” form of birth. This attitude does nothing but make women whose births aren’t as easy or whose milk doesn’t come in feel completely and totally inadequate. Even mothers whose lives have been saved by modern medicine (and let’s not forget that no matter how “natural” childbirth is, without modern medicine 25% of women would die from it) have been made to feel guilty about not having had a natural childbirth.
They - the preachy, whining, nattering, guilt-inducing, anti-science, anti-medicine, natural-at-all-costs birthing teachers - are why women are turning away from birth classes.
— CharleneAnother reason is that childbirth has been occurring naturally for thousands of years. My wife opted out of a class and read a book on (and used) the Bradley method instead.
— JRMNice, relevant post, TPP. I think the penultimate paragraph, where you mention that lots of variables change during labor/delivery and women need to be able to make informed choices really hit home for me. I know two women in the NYC area who were not prepared to make certain decisions during labor and found themselves being “pushed and bullied” (in their words) into C-sections that they did not want after their OB decided that they had labored too long. (Gee, I wonder what people did in the old days, before Pitocin?)
Both of these women ended up with unexpected C-sections and they both suffered from postpartum depression because they were so unprepared for the labor experience that they ended up traumatized. Neither one of them had taken a childbirth class.
On the other hand, I know midwives who would blanch at the idea of teaching pregnant women in a childbirth class about the various interventions typically available to them, since they, the midwives, don’t believe in any interventions at all.
As a woman who will probably give birth in the next couple of years, I would really like to see a more balanced take on childbirth, instead a purely medicalized versus purely natural ideology.
— SarahFor me, this is mixed news. As a former midwife and the participant in 3 drug free births, I’ve always thought that child birth classes were a sham. The best preparation for childbirth is knowledge of the process and time spent assembling your birth team; once the real contractions start and things are popping, one needs to embrace both the pain and the process; “‘cuse me while I kiss the sky”. Giving birth without drugs, feeling every last sensation leaves a woman feeling invulnerable and strong, we are ready to take on the world and offer no quarter; little wonder why the powers that be try to deny us the experience. Lamaze offers a false hope for a pain free birth, leaving disenchanted people in its wake. A woman can not be her own advocate during birth, it’s way too intense to be able to form a cogent thought, much less use that energy to try to get what it needed.
Popular entertainment has done much to inculcate us to the horrors of childbirth. Trauma and chaos make for more drama, there are too few depictions of normal, happy birth—that’s too boring! From early on we are told of the inconceivable pain and general yuckiness of our child bearing abilities (think “the curse” of menstruation) and fear of the awesome powers of birth. I firmly believe that if we are to truly reach our potential as women we need to reclaim birth as our birth right, replete in the knowledge that we can and do give birth.
— PamelaChildbirth classes are not usually covered by insurance and the price has been rising. Where I believe hospitals used to offer them for a small fee, many hospitals here in Boston now outsource to private businesses that don’t feel the need to be inclusive. When I was first pregnant I did take a childbirth class ($197) and it was a huge waste of time and money.
— PetraCan it be women in their childbearing years are more educated about childbirth than they have been in past decades due to better education in school and on the internet. I remember my mom going to those classes when I was 9 15 years ago. I can still do the breathing excersizes although she never used them (C-section). For that matter I got to watch the birthing video in high school health class which not many people can forget.
I strongly believe women need to be educated during their pregnancy about all options and complications during childbirth but in an era with C-section/tummy tuck births a breathing class seems too institutionalized. After all no two pregnancies are alike so why should a woman except a class covers her needs.
— KristieLeeHeh. This is funny. There are a lot of ways to waste time and money when a baby is due, but my wife and I never felt so duped by the materno-industrial complex as we did when we dropped 400 clams on childbirth classes. It’s the first thing we tell our preggers friends that they can do without.
Making “informed decisions about procedures like epidurals, episiotomies, induction and C-sections” is something that couples should do in consultation with their Ob-Gyns. The fact that childbirth classes
gloss overcover this stuff is nice, but most people go to these classes so late in their pregnancies that this kind of discussion, especially in the presence of a bunch of strangers, often seems to instill more unnecessary panic over birthing options, especially when episiotomies, induction and C-sections are unlikely to be necessary for most of them. (What might be more interesting and useful are classes on the way hospitals encourage procedures such as C-sections as a matter of policy when they aren’t necessary.)It seems to me that fewer women (and their mates) are taking these classes not because they are less interested in learning about the end of pregnancy, but because they have learned, or at least suspect, that these classes are another mostly useless way of exploiting their fears and concerns about the momentous event, and another way of extorting another few hundred dollars from them for information that, these days, is readily available to them from the comfort of their own homes and doctors’ offices and from their many, many friends who have been chumped by these classes.
— breakingballPerhaps fewer women are opting for Lamaze childbirth classes because they don’t believe the fabrications taught as part of a highly ideological agenda.
Ms. Crenshaw of Lamaze International unwittingly illustrates this perfectly. She claims that women “are convinced they can’t deliver a baby without epidural pain relief”. Anyone can deliver without pain relief. Approximately 99% of the mothers who have ever existed have delivered without pain relief (or died trying) and the majority of women giving birth around the world each day do so without pain relief (or die trying). No one is worried that they can’t do it; they see no reason why they should do it.
Crenshaw also claims that “serious problems are exceedingly rare among women delivering in the United States.” That, too, is a complete fabrication. Childbirth is inherently dangerous, and is one of the leading causes of death of women and babies in every time, place and culture. Bad outcomes are now exceedingly rare among women delivering in the United States, but that is because of modern obstetrics. Serious problems occur at the same rate that they always did; the only difference is that they are now treated successfully.
Ms. Crenshaw also manages to blame women for not taking classes, asserting that they are too busy to do so.
Women are fed up with the self serving agenda of many childbirth education classes. Unmedicated childbirth is NOT a model toward which every woman should aspire. It is a personal preference, and it is no better, safer or healthier than choosing pain relief. Childbirth is NOT inherently safe; low rates of maternal and neonatal mortality occur only where modern obstetrics is practiced. Women are not to blame for refusing to attend childbirth educations classes; the educators are to blame for putting the desire to glorify their personal choices ahead of women’s needs for accurate information.
— Amy Tuteur, MDChildbirth classes often put women against their doctors. Instructors imply that doctors will push women towards medications, procedures, inductions and c-sections, while ignoring the fact that labor and childbirth can be horribly painful and cause long- term damage to a woman´s bottom. I wish my instructor told me that before I went through 48 hours of labor and needed a C-section because my baby’s head was in a slightly wrong position. My pleasant and suposedly qualified childbirth instructor also said scary things about c-sections, which were completely untrue, since I was up and running in 2 days.
— Camila CorreaI am all in favor of people being educated as to what is going on with their bodies. But childbirth classes have a belief system behind them, as OB-GYN doctors do, with the difference that doctors studied for at least a decade and childbirth students are prepared by about 12 hours of class.
I am not surprised or sorry that these classes are losing importance.
My doctor said it would be nice to catch a class if we could schedule it, but if not, don’t worry about it. Birth happens whether you take the class or not. So we found a quickie class (two afternoons instead of six or eight weeknights).
If I had to choose between giving birth again or sitting through another childbirth class, I’d take childbirth.
It was boring, condescending, and full of people minding each other’s business. Plus the gal teaching it was an extremely militant nursing consultant and turned it into a platform for her views (and a subtle ad for her nursing consultant business).
It was, I must say, an older and fairly well educated crowd, so everyone pretty much knew everything already and just went because that’s what you do.
— diI think it is a matter of choice. If women choose to have a baby, they want to choose to have it in whatever way. Most women work hard and don’t need a earn a medal to go through childbirth without pain relievers.
— jackieI find it so disheartening that women seem to have accepted the inevitability of relinquishing control during childbirth to their doctors. Many women I know seem to think that childbirth is a horrible ordeal to get through with as much medical intervention as possible making it as easy as possible on them. If they are just going to go in, get an epidural, get that episiotomy and vacuum extraction or, more and more likely, a c-section, well…what’s the purpose of a class, anyway?
There is still a significant subset of women, however, who take control of their own bodies and have meaningful, intervention-free births, whether in a hospital, birth center, or at home. Many of these women avoid “mainstream” childbirth classes due to their focus on medical intervention. There are a number of wonderful books available to help prepare for birth, my favorite of which is Ina Mae’s Guide to Childbirth. Many women who pursue natural childbirth, particularly out of hospitals, find that they are able to prepare quite well through reading and talking to other women, without the need for a formal birth class. The most educated and well-prepared women will have a thorough understanding of what interventions may be necessary if the situation arises, and are prepared to make those decisions when the time comes.
Modern obstetrical care has helped so many women, but it has hurt many as well. I wish that women in this country would open their eyes to the reality that our birth outcomes are poor compared to much of the industrialized world, and see that a reliance on medical intervention for normal birth may not be as ideal as it seems at first glance.
— EllieAs a former childbirth educator and someone who had three non-medicated “natural” births, I am concerned about the trend away from childbirth classes. I fought to have my husband in the labor and delivery rooms. Even in the late sixties, men were actually handcuffed and arrested when they tried to stay with their woman - can you believe? I fought to NOT have an episiotomy, keep my feet out of stirrups, have as little fetal monitoring as possible, have loved ones nearby, and drink fluids instead of having an IV line in my arm. I wonder why these things were important to me? I have decided that these were my reasons:
1. I believed that birth is a natural process, not a medical procedure. I wanted to feel it and understand how to work with it as women have through the ages.
2. I felt it was best for the baby for me to be unmedicated. If there were complications, I was ready to accept medical intervention.
3. I practiced natural pain management with my husband and we both understood the stages of birth. My mother and my friends didn’t know enough to help me - most of them had scarry stories to tell. I was afraid, but I wanted the understanding I got from classes to reduce that fear.
4. I wanted to feel empowered as a parent and a woman. With each birth. I felt immensely powerful afterwards. I wanted my babies to be fully alert, to breastfeed immediatley (which nature intended so the uterus would contract - now we use an injection), and to stay with me so I could really bond with them. And I was lucky that all these things came true.
Maybe all these choices and benefits are available to women with the newer epidurals, or maybe women don’t see these reasons as important. I am not judging women who use medication. But many medical professionals have never even seen a birth without an epidural, so they can’t support the full range of natural possibilities.
I wonder if women have given up seeing the birthing process as a normal, natural process that they can control themselves, understand their choices and get adequate support for them, and view medical personnel partners who are ‘assisting them’. Classes make these choices clear and realistic - if the instructor has personal experience with them. Just questions from a grandmother who truly enjoyed giving birth and wants the best for future generations…….Ellie Taylor, RN, MS
— Ellie TaylorChildbirth classes are time consuming, and not always cheap. A baby will be born with or without the benefit of them, and the outcome of a birth is apparently not affected by whether one devotes time to this activity in advance or not. Familiarizing onself with the choices one must face during the process of childbirth can take 30-40 minutes of concentrated reading about the topic; it’s not necessary to spend time attending childbirth classes to do this.
In short, childbirth classes are likely not perceived as efficient use of one’s time in advance of an event that inevitiable one way or another.
— Name witheld