Should I bother taking a childbirth class?

This was a question recently posted on a Facebook group of mothers who are hoping to birth naturally. The consensus of mothers who responded was essentially, “Nah! You can learn everything you need from books and online.” There seems to be many variations of this question lately, so perhaps it’s time to address it in a thoughtful manner.

What I am about to explain is really important, because an independent childbirth class is one of the best investments you can make in creating the safest birth possible. Yet I see mothers looking for free on-line resources because their hospital class is too expensive at $45, or $60 or whatever the local going rate is.

I am fully supportive of mothers educating themselves anyway they can. I am an admitted bibliophile. I have a lending library of my favorite pregnancy, birthing and breastfeeding books, including one I wrote (available in paperback and eBook) that I hope everyone will read: Mother’s Intention: How Belief Shapes Birth.

I also frequently scour the internet for the latest information. I can tell you, with 23 years as a childbirth professional, there is a plethora of misinformation out there. The problem is, you don’t know what you don’t know. If you are a first time mom (or an experienced mom who has only seen conventional hospital birth) seeking out information based on the most prevalent cultural biases, you will find a lot of bad information that will not get you a natural birth if that is what you seek. This is not judgment. This is a factual statement backed up by evidence. About 4 million women give birth each year.  About ¼ of those will take a childbirth class at tall. Most of those will take the cheapest class with the least amount of time investment involved.

How’s this working for women? Surgical birth rates are now more than double what the WHO has stated is optimal to save lives: Almost 33%. Induction rates are out of control leading to increases in iatrogenic (doctor causes) prematurity. Daily, the Improving Birth #BreaktheSilence campaign shares heart-wrenching stories of women who went into their births thinking they just had to show up, or thought they had informed themselves adequately, but found they were woefully ill-equipped to deal with coercion, manipulation and misinformation. The website, My OB Said What?!? shares story after story of women who are treated badly in birth by doctors and midwives who seemed really nice. Women come to my classes for second, third or fourth babies, wounded by their previous birth because they believed all they had to do was trust the ‘professionals.’

Thus, I say kudos for even looking for information. Some women just don’t bother. One woman recently wrote in The cult of natural childbirth has gone too far, “When my doctor asked me what my birthing plan was I told her I was looking at it.” Having put all her eggs in this one basket, when she went into labor during Hurricane Sandy, her (non) ‘plan’ was shot. Her labor, “…wasn't pleasant or "natural,"" unsurprisingly.  

Her take-away from this experience was that anyone who would want to birth naturally must be of the ‘cult’ of natural childbirth….as if there are not legitimate psychological, physiological,  anthropological, sociological or philosophical  reasons for desiring a natural birth.

My take-away was that every woman should have to take a childbirth education class as soon as she starts menstruating. She should not only know precisely how the female body functions and how birth works, but how to give birth (as opposed to ‘being delivered'). Because here’s the thing: epidurals sometimes don’t work; epidurals sometimes are contraindicated; weather happens, natural disasters happen, man-made chaos happens, cars break down, traffic jams happen, precipitous births happen. There are so many reasons you may be alone without assistance to birth your baby. If you do not know what your body/baby are doing, the fear/tension/pain/ cycle is initiated and the whole process is likely to be miserable. It doesn’t have to be. 

Not to mention that the sentiment of, 'No, I didn't take a childbirth class, that's why I hired my midwife/physician/doula for' is intrinsically flawed. A midwife or physician isn't there to educate you in most cases. They will tell you to take a class for that. They do not have the 12+ hours it takes in addition to monitoring the health and wellness of you and your baby which is their job, to educate you on options, informed consent, anatomy, physiology and biology, or patient rights. Hiring a doula does not absolve you from those responsibilities either. They are there to provide emotional support and in some cases act as a consumer advocate, but even then, in the throes of labor it is not their job to try to educate you, from the ground up, on what options are available to you and why. Nor is it their job to run interference for you with a caregiver with a diametrically opposed birthing paradigm or to be in an adversarial position or environment. The purpose of a childbirth class is to make sure you have laid all of the groundwork for an optimal birth experience beforehand, and to make sure you have some small grasp on how you might navigate challenges and road blocks knowledgable and without regret.

THAT is why budgeting for an independent childbirth class is important.  

In the last six months or so, I have gotten five inquires regarding my HypnoBirthing® classes. Two of those inquiries asked me to shorten the class series because they figured if they didn’t take as many classes, I would charge less. (I will explain in a moment why that is not possible.) Both of these were expectant mothers in professions requiring an advanced degree from two-income households. I fully realize that perhaps that doesn't mean anything regarding financial security. I do not know anyone's story. However, neither do people know mine when they make such a request. And it's complicated. I don't judge anyone for how they must place their priorities and I don't hold it against anyone trying to budget. There are currently things I deem very important that I cannot financially contribute to financially. I get it. I'm just saying that sometimes people making these requests actually are quite a bit more financially secure than I am, so they likewise shouldn't hold it against me when I can only do so much to help them. 

One inquiry also wanted to reduce the class length (because she was due soon) and because of that felt the price should be reduced. Since she was some distance from me, I offered to conduct the full series via Skype. Because I would not have to pay for a venue, account for travel time, mileage or gas, I offered this class at a price $90 less than my $250 class fee.  I felt that was pretty generous. Two other inquiries were requests for military discounts, which I happily provided.

Even though I offered to do whatever I could to make sure that anyone who wanted to take a HypnoBirthing class could take one regardless of their financial situation…short of the class actually costing ME money…only the two military moms ended up taking class with me. (They had BEATUFIFUL births, BTW.)

Two of these women actually wanted detailed information on how I came up with my class fee.

I find that odd. When someone hires any other professional, do they request a detailed account of just how the professional arrived at their fee? I have never hired a plumber, contractor, electrician, doctor, dentist or physical therapist and asked them first to itemize their hourly fee in justification. I think that the reason this happens to childbirth educators is because many hospitals offer very inexpensive classes. Often these classes are not only (comparatively) inexpensive, but require just a time investment of a few hours on the part of the parents.

The reason for this is that is two-fold. I know this as I have taught in two different hospitals.

1. Hospital-based childbirth classes are subsidized by pharmaceutical companies, diaper and assorted manufacturers of baby paraphernalia. They underwrite the expense of the class in exchange for the opportunity to market directly to you. This includes being provided a mailing list with your name on it so that they may market to you in perpetuity. Your class materials are made and provided by people who want to sell you stuff. That's why your email and mail box start filling up with advertisements and coupons. Your name has been sold to an untold amount of manufacturers. 

I work ONLY for YOU.

The hospital, then, has little overhead for these classes. They have the salary of the nurse teaching the class, which is likely at least $30 per hour. The venue is an existing part of their facility, purposefully. Over the years, I have been informed by three different OB nurse-managers that the birthing facility at any hospital is their best marketing tool. If they can get you to birth at their hospital, you will bring future broken arms, heart attacks and illnesses to their doors. Thus, it is very important that you be really comfortable being within their walls.

2. The material you will be offered is representative of what you will be offered at their facility, not the myriad of options actually available to you. Think about it: If you are not able to eat or drink while in labor at their facility they are going to tell you that you are not allowed to eat or drink in labor. They are not going to add that the birthing center down the street does allow that. They are not going to tell you the many ways to turn a breech if one of the two doctors at that facility automatically schedules surgery for breech. They are not going to tell you the risks of an induction if that hospital has a 70% induction rate because two of the three doctors at that facility routinely induce at 39 weeks. (Yes, these are real examples.)

Not only that, but at $30 an hour, if you had a skilled professional who could be saving lives wouldn’t you prefer to limit the amount of time that person was in a classroom with a handful of people telling them how to be good patients?

In stark contrast, I have to provide the class in the format in which it is offered. I signed an ethics agreement with the HypnoBirthing Institute, and the syllabus is 5 classes, each 2.5 hours, 1 week apart. I am allowed to offer a ‘plus’ addendum for mothers who want some postpartum/early parenting instruction, but I may not offer it as part of the series. In rare instances I may conduct the 12.5 hours of instruction in truncated form. For instance, if someone doesn’t find me until the last month of their pregnancy, or a partner works a swing shift and the only time the two parents are available at the same time is on the weekend, I may offer longer weekend classes and do it in a week or two of weekends, etc. but I must provide ALL of the material in 12 hours +/-. 

This is for the protection of the parents. There is really nothing in the 5 weeks of instruction that can be left out while still providing the same level of education & experience. If someone is telling  you they can provide it in less, they are in violation of their ethics agreement which should make you question what they are leaving out. This class isn't like most childbirth classes. I've had doctors and nurses take the classes and say they learned quite a bit!

Likewise, just reading the HypnoBirthing book will not teach you what you need to  know. HypnoBirthing is not just teaching the technique of hypnosis and voilà! Easy birth. It’s about releasing fear, the interaction of other parents, the expertise of the educator, practicum of many hypnosis techniques, and the facilitation of effective communication techniques with care providers so that you are more likely to be able to CREATE the birth you seek. It’s not luck. I’ve had people take my class after figuring they could just buy the book or take another hypnosis for birth mail order class that was cheaper, and then find that they could not reach the level of confidence they felt they needed for it to work for them.
Birth isn't a cerebral activity. 

That being said, The HypnoBirthing Institute does not regulate how much I charge. I currently charge less than others in the area, and less than the HypnoBirthing fee average across the board, but I’m also totally willing to exchange energy. I am of the opinion that if a woman really wants this experience, she should have it. I’ll work with parents, if I can. As long as I don’t end up subsidizing someone’s birth by putting more time and energy into it than they do, and it doesn’t /cost/ me to teach, I’m game. 

In order for this to not be my expensive hobby I must allow for:

Teaching Time.

People may assume that this is just the 12.5 hours I am in front of them speaking. Sadly, this isn’t even close. For every hour I am actually in class, I have about an equal number of hours preparing out of class. Sometimes more. This might include (but is not limited to): Responding to email questions from clients, printing handouts, researching the latest evidence-based care in childbirth education, etc.

Travel Time.

Yes, I have to pay myself for my time on the road, my gas, the mileage wear and tear on my car, just like any other professional. If I’m teaching from home…bonus! I don’t have to charge much for walking down my stairs and setting up my equipment. However, I still had to purchase that equipment and it does actually still take time to set up and prepare for a class. My husband is still inconvenienced in that he has to occupy himself elsewhere for a time. While I no longer have to consider this, some independent CBEs have to pay for childcare, too. If I’m traveling offsite, sometimes I drive an hour each way. That is an hour I’m not doing something else that might contribute to my household income.

If I am presenting at a venue outside of my home, that usually means that at least 20% of what I make goes to the venue off the top.

No matter where I conduct class, I try to provide food and drink, which is usually anywhere from $10-$20 per class, depending on the size of the class.

Continuing Education.

In order to remain certified through the HypnoBirthing Institute I must fulfill continuing education credits. This often requires travel to attend conferences or classes. In order to remain insured (which also costs money annually), I must be a member in good standing with the National Guild of Hypnotist, which also has a continuing education requirement apart from the HypnoBirthing CEU options. This may also require travel and/or the expense of classes or conferences. There are also dues to be a member, just like in any trade organization.

Foundational Expenses.

Just like any other business, I maintain a web site I must pay for, I must conduct free presentations on occasion to promote my business, which not only requires an investment of time, mileage, gas, but promotional materials such as business cards, brochures, posters, mailings, etc.

Class Materials.

In addition to teaching aids (movies, charts, teaching baby/uterus/pelvis, etc.) HypnoBirthing class materials include a 1/2 inch binder full of handouts I must print for each couple and the official HypnoBirthing text/CD set. This set is ONLY available in a HypnoBirthing approved class and is NOT what you purchase if you get the book from a store or online.  

No one pays any of these expenses for me. All of the expenses must be paid before I can even think about paying myself an hourly wage.

I usually teach 4-6x per year, with anywhere from 1-6 couples in attendance. The most I’ve ever had in a class was around 12 couples, I think. I keep the classes small intentionally. There is a tremendous amount of material to cover and discussion is usually lively. If the class is too large, the couples often cannot form the relationships that lead to comfort with such intimate discussions. However, I would absolutely teach every night of the week if I could! If I did, I would happily pass the savings on to parents as much as I could while still contributing to my household income.

As you can see, I do this because I love it, not because I’m getting rich. I do believe my 23 years of education and expertise should allow me to make a living, though. I’ve earned that right.

I’ve seen amazing births as a result of it. I’ve seen women (and families) transformed by it, and I’ve made some really great friends along the way because of it. I’ve even been told I’m really good at it! :-) So, I will work with you in anyway I can that will meet both of our needs. 

Sadly, when someone decides that an independent childbirth class isn’t worth the money for their first baby, I’ll see them for a subsequent birth, but they’ll come to that class because of a hurtful first experience. This is not the place to pinch pennies. You get exactly what you pay for. After taking my class, I’ve had people in tears asking why they never learned this when they took their first, in-hospital class. I’ve also had people take both my classes and a hospital class, only to tell me they are almost teaching the hospital class because the actual instructor isn’t sharing this vital information with the other parents.

Women spend months and sometimes tens of thousands of dollars to make decisions about their wedding, yet balk at what amounts to them as $20/hour for a few hours to prepare for their birth. Nurseries are planned, remodeling is done at the expense of often hundreds or thousand of dollars. We train for our jobs. Motherhood is THE most important job. The decisions you make about your birth can have lifetime of health and financial repercussions for you, your baby and your partner. Heck just avoiding an episiotomy or unnecessary first cesarean more than pays for the investment of a really great childbirth class. Like mine! 

My birth work has revolved around helping women face birth Fearlessly with a capital F. 

Tokophobia  is the fear of birth. This fear may be present in women who have never given birth, due to stories they've heard or cultural influences. Some of these women may choose to remain childless solely due to this fear. Some may decide to have children at some point, but will base their birthing decisions on this fear; for instance, choosing to have a surgical delivery because their fear of the process of natural birth is overwhelming. Making decisions from a place of fear, especially if the fear is based on an erroneous assumption that has become a limiting belief, means that some women might make decisions that are not in the best interest of themselves and/or their baby.

The fear may manifest in expectant women who have prior bad experiences. Sadly, too many women entering the U.S. maternity care system come out disempowered, sometimes physically damaged or both, many suffering symptoms of PTSD.

Over the years, many women have shared their fears with me, so I have an idea of what the most common fears are. However, I'd like to understand more completely so that I can try to help address fear where it originates. Please forward the following survey so that I can gather the most complete picture possible. Thanks.

NOTES ON SURVEY:

The survey is now closed. I have the data and I even had someone working on a chart representation. The data has not disappeared down the black hole that is my desktop. (Though it is circling the event horizon.) Life has intervened, but I will post it eventually.

As I'm sifting through all this old stuff, I realized that I don't think I ever did say much about my trip to Singapore to speak at the National University Hospital.  This might be because I was slightly preoccupied with the economy class DVT I had to deal with upon my return, but still it's sad because it was the trip of a lifetime!

Nearing the never ending Wisconsin winter of 2011 my friend Di Bustamante of Parent Link in Singapore and I were chatting on Facebook. I was complaining about the cold and yet more snow I'd have to shovel. She was LOLing as she enjoyed the content 75-85 degree temps of sunny Singapore. Then she asked me a question that changed my life in so many ways..."Would you like to come to speak at an even in Singapore?" I said, "YES!" without thinking twice. I live by the sage advice Tina Fey said she got from an acting coach (if I recall correctly): Always say 'yes.' Then figure out how to make it happen. 

Honestly, I just wanted to thaw out. 

I was to fill in for a speaker who had to cancel, so the line-up was being adjusted. The topic was Kangaroo Mother Care, which I knew a little about, but would require a crash course in order to speak cogently on the topic. 

I feel it is important here to provide a bit of background. I am from a little tourist town of about 9,000 people. At the time of this trip, I had moved to a Wisconsin city of about 45,000 people. Big cities freak me out. I've traveled internationally, but never to Asia. I asked around for travel advice and many people, including my own doctor, made sure to tell me to take antibiotics and digestive meds. This amused my friend Di. She said, "You do realize Singapore is a First World Country, right? You can drink the water." 

I set about making plans for the trip: researching and writing about the topic (the information distilled for the presentation eventually was published in Midwifery Today) and making travel plans.

Initially, my husband was going to go with me. His work prevented that. We tried to figure out a way for my grown daughter to go, but that didn't work out. Then my dad was going to go with me, but that fell through. As the trip approached, this small town girl was realizing that she was about to travel 1/2 way around the world, alone, to a great big city. 

I was terrified.

Fortunately, my friend Di was sympathetic, worldly and witty. She walked me through the entire trip, from planning to my return. 

Here is might be a good idea to interrupt the story to explain that the reason there are links for all of the places I visited instead of pictures is because all of MY pictures look a lot like this: 

SO...

I arrived at the stunningly beautiful Changi International Airport. Di had suggested that I just take the MRT, which is the Singapore public transit system which about put me into a full-blown panic attack. I'd never taken a city bus and my one excursion on the 'L' was scary as hell. (When the conductor says, "Oh NO! You folks don't want to get off HERE! I'll take you back a couple of stops" you don't question it.) She finally assured me that the warnings to visitors about how hard it is to get a taxi are overblown, so that's what I did. (I needn't have worried about public transport, incidentally. I visited the train station later and it was clean, safe and efficient. I was envisioning what I had seen of U.S. train and bus stations, which had been pretty darn daunting, disgusting and scary. In fact, all of Singapore was easy to navigate, safe and clean. One of the expats commented that Singapore is a great first foray into Asia because it's 'Asia light'...meaning it is easy to get around, most people speak English, and it is so safe and clean.)

I was deposited at The Chinatown Hotel. I actually do have a clear picture I can share from my room: 

What do you notice about this picture? Why, yes, the commode and the sink are IN the shower! 

Mind you, since it was just me, I got a small, inexpensive room. The accommodations had I traveled with my Dad (or anyone else) would have been quite different. Singapore has some of the most luxurious hotels in the world. I wouldn't have been in those either, but I made note of a nice Holiday Inn in a convenient location I'd check out next time. 

The next day was a HypnoBirthing® training conducted at the Petra Hypnosis offices. Besides Singaporeans, attendees included women from Korea, Australia, Canada (some of the attendees were ex-pats living in and around Asia) and elsewhere. The first night Fauziah treated us to a delicious Indian meal, and the second we went to one of Di's favorite eateries, which was also fabulous. (And where the fuzzy picture above of my new expat friends was taken.)

Next up was the reason for the whole trip...my contribution to the National University Hospital event.

Despite being provided with a map, I got lost finding the auditorium in Tower Block because this place is HUGE! 
Singapore boasts a world class healthcare system, "...being reviewed as a model by the Obama administration’s healthcare team as it explores ways to reform the US healthcare system" as it should. NUH is a certified Baby Friendly Hospital, a distinction that few U.S. hospitals can claim. (6.9% of U.S. births occur in Baby-Friendly designated facilities.) Singapore ranks much higher in infant mortality (with 2.5 infant deaths per 1,000 live births) than does the U.S. (with 5.9 infant deaths per 1,000 live births). Singapore is loses fewer mothers, with the U.S. at 21 maternal deaths per 100,000 births and Singapore at 3. THREE!

I gave my presentation, I learned much from the other presenters, and even had a bit of time for Di and her lovely daughter to show me around. We saw the Singapore Botanic Gardens and then I tried to keep up with Di as we hiked about Bukit Timah Nature Reserve. Gorgeous! 

I went home, wrung out my clothes (we were hiking in a rainforest, for pity's sake!), showered and took a nap before catching my plane home.

22 hours later when I arrived in Chicago, my right leg hurt quite a bit. It had been bugging me the whole week, but I thought I had leg cramps from so much sitting. I massaged my legs, stretched and walked trying to get the kinks out. Likely, I had the clots from the first flight (which cut me off at the knees...United Airlines seats SUCK!) and didn't know it. In fact, looking back over the previous year, I have to wonder if it had been building all year with about monthly 9-12 hour car trips and a week long flu that left me dehydrated. 

People have commented that I was lucky I didn't throw a clot there. I am, but not for the reason people assume. I am positive I would have received the very best care there. I just don't know how we would have paid for it! I think we're still paying for it from the care I received here and we're insured!

Anyway, I went to bed, got up and went to work the next day. I worked at a Wellness Center, and after a lunch meeting I told doc my legs hurt and asked him if I should be concerned that I had cankles. He sent me directly to the hospital for an ultrasound which showed several clots in my right leg. She didn't even look at my left, which also ached but didn't hurt, per se, and wasn't swollen. 

Off to the anticoagulation center for Fragmin shots in  my belly for 9 days, Warfarin, and daily INR checks. If you don't know, Warfarin is rat poison. It is very effective in thinning the blood. In that first month, I popped a blood vessel in my hand for no apparent reason, and when on this drug, these are the types of things that you have to consider: 

"If that happened in my hand, it could happen in my brain."

"I wonder how long I should wait to see if I stop bleeding before I lose a finger?"

"I wonder if I should be concerned about bleeding to death?"

It's rat poison and it feels like rat poison to take it. I gained 20 lb. in a month that I never was able to lose, (which the nurses insisted was not a side-effect, but upon visiting chat groups I found was a very common problem) I needed 4-hour naps every day just to function, and I would say that would be an exaggeration of what I was actually doing. 

The blood tests I had done when the clot was discovered showed that I tested heterozygous (as I understand it I have one gene mutation out of two possible) for both  Factor V Leiden and Prothrombin II gene mutations. My grandma also has this problem. It was being suggested that I spend the rest of my life on Warfarin like her. She has had several heart attacks and several incidents of being hospitalized for internal bleeding because this 'therapy' is notoriously hard to manage. 

As soon as I could be fairly certain that the clots were stabile, I researched other ways to manage 'thick blood' without being afraid every day of my life. 

Thus ends the tale of my journey around the world! I faced my fears and did it anyway, coming away from the experience enriched, with new friends, a little less fearful, and with new knowledge about my biology. WIN!

I'd go back in a heartbeat...on a better airline with prophylactic measures taken to avoid blood clots! I still don't feel comfortable in U.S. cities, but Singapore is a city I actually enjoyed and would like to explore.

Mother's Intention can be purchased at Amazon.com

An example of one of these unsupported practices is that of routine gestational diabetes testing in the absence symptoms or risk factors. A Guide to Effective Care in Pregnancy and Childbirth states, “The available data provides no evidence to support the wide recommendation that all pregnant women should be screened for ‘gestational diabetes’...” (pp. 59), and for good reason. In Understanding Diagnostic Tests in the Childbearing Year we find that this test is not reproducible 70 out of 100 times! It’s not accurate; it’s harmful to women (in that it is a ‘fasting’ blood sugar test, requiring a pregnant woman to go without food for 8-12 hours, and then ingest pure sugar syrup despite the fact that her pregnancy physiology makes her less able to cope with this unnatural overload), yet it is the ‘standard of care.’

Another example of nonsensical thinking is the story of a friend who broke her tailbone four days past her estimated due date.

She obviously was in a great deal of pain. At the hospital, she was told all they could give her for the pain was a commonly available pain reliever because anything stronger would be bad for the baby. BUT…if she went into labor, (or if they just would let them induce her), she could have an epidural or Demerol. She responded with, “Excuse me? Why is it not OK to relieve the pain of a pathological condition that is by its very nature painful, but it is OK for a normal, physiological process that can be quite comfortable without drugs?” (More on that later!) If she went into labor in 10-minutes she could have the drug, but not now? How does the difference of 10 minutes make the drug less dangerous? The same rationale makes it not OK for a mother to have narcotics/opiates in her system if she puts it there, but it is OK if the anesthesiologist does? I am not advocating illicit drug use here. I’m simply pointing out officially an estimated 76% (Sakala & Corry, 2008) of our babies are born under the influence of epidurals. Some admit that in their hospitals, the numbers are closer to 90%. (Mothering, 2010) Epidurals are comprised of narcotics and ‘caine drugs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   We ignore the nonsensical, the lack of evidence and the disingenuousness in our maternity care system at our own peril. If we do, we make our decisions and base our behavior based on misinformation. If choosing the interventions means choosing the consequences that’s a costly mistake to make. If we aren’t willing to demand accountability those mistakes are repeated, improving nothing. I hope to help those that expect more of themselves and for their children.