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:
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.
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.
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.
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.
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.
by Kim Wildner
When Ricki Lake appeared on The View at the time of the release of The Business of Being Born, Barbara Walters that interested me. Lake is explaining how having a natural birth at home with midwives empowered her. Walters is confused by that.
This started me thinking about how many women do (or don’t) take childbirth classes and why that might be. Of course, partially that is because at the time I had a poll on my blog asking people if they took classes and why or why not. At the time of this writing, 52% did not take a class, and most respondents who didn’t take class said it was because they didn’t need one.
Of course, you know I’m going to ask ‘why’ next, right? Did they feel they didn’t need one because they figured they’d blindly trust whatever their OB told them? Did they not understand the purpose of a childbirth class? (Hint, it has nothing to do with ‘breathing’…you must know how to breathe already or you’d be dead and I hate to say it, but there is no magic breath that gets babies out.) Did they have a midwife as a caregiver, and had everything explained to them (and had actually helpful books recommended to them so they could educate themselves) so that a childbirth class was redundant? Did the non-hospital childbirth classes not market themselves well?
It was this last question that was on my mind when Maslow’s Hierarchy of Needs came up in conversation. Now, this pyramid of needs has tickled the back of my brain on and off periodically. This time, I realized why it kept bothering me.
First, a nice visual of Maslow’s theory can be found following this link.
The basic idea is that when we make a decision about something, these are the factors that will motivate us. First, we are concerned with survival issues. If our basic needs are not being met, we don’t really care about the other stuff.
Next, we need to know we are safe and secure. We need some order in our life, some predictability and to be part of a larger whole. This is also about survival to a certain extent. Being part of the larger group is an evolutionary desire. We are tribal by nature. Solitary humans don’t do well, not just because we need others to be most effective at hunting, gathering, farming, etc., but we need social stimulation for the sake of our brains. If we don’t interact, we go a little bit nutty. Think of the movie Cast-a-way with Tom Hanks.
Beyond that even, we need to fit in with our family, peer and work groups. We have a need to feel appreciated and loved.
We can survive if the only the first two needs on the pyramid are met, but without the third, we probably would be slightly maladjusted.
Next, we have the need to feel special. We want to feel respected and to be able to feel pride in our accomplishments. Finally, we reach a state of enlightenment or our full realized potential. Some say not many of us get to that point.
Ok, so how does this relate to birth, childbirth classes and Barbara Walter’s bewilderment?
Here’s my theory:
Most American women are still making decisions at the first two or three levels. They believe birth is a dangerous, excruciating medical event. They want to be able to predict exactly what will happen each step of the way, even if the security is an illusion. If they do what every body else does, not only can they have a plan, but its familiar because it’s what everyone they know has done. They are following a blueprint. Sadly, because they do what everyone else does, they get the experience everyone else got, which is likely the painful medical event. But that’s ok with them, because they all have the same war story to tell. They fit in. They also get admiration for ‘surviving’ such a harrowing event.
Those of us who make the decision to birth at home, or who take a class that advertises gentle and empowering birth, are doing so because we are not operating from a place of fear. Make no mistake I am NOT saying we are ‘better’ or ‘higher’. I’m saying because we are confident that we are safe, and our babies are safe, we are not operating from survival need. Because we know what the research says BIRTH is safe, we are not operating at security need. Hence OUR confusion when someone says, “You birthed at home? Oh, you are so brave! I could never do that!” We, of course, are thinking, “Sure you could.” We don’t consider ourselves brave at all. We are just doing what makes sense, personally and per the evidence.
We are working from the ‘esteem’ level, because we can. We feel a need for a sense of accomplishment like anyone else. We feel a need to be respected by our spouse or our home-birthing friends and to feel unique. Now, we all have these needs, but what I’m saying is that we can make our birthing decisions from this level because we don’t have to worry about the first three needs. To try to empower a woman who is operating at a survival or security level will not work. She has other things to worry about. Not to mention, if she is in an unsafe environment, or doesn’t have access to nutritious food, or is in some way actually not healthy, she actually is at risk for complications, which means she’s operating at exactly the level at which she needs to be operating. This is why it is absurd when people say homebirth supporters are trying to ‘make people feel guilty’. Even the most strident homebirth advocates realize hospital birth is the only place to be for about 10-15% of women. Homebirth should be an option because it’s safe, not because it’s right for everyone.
Think about it like this: You feel education is important. You improve the schools, and you make attendance mandatory. But one kid just doesn’t seem to care. He is often truant, and when he is there he doesn’t make much of an effort. You try to tutor him. You try special classes. You try rewards and punishments, but nothing works. He just doesn’t seem to value education.
What if you found out the kid was homeless? What if he’s being beaten at home, or doesn’t get to eat every day? What if he was convinced he was worthless because he was told he was, every day? If you met the more basic needs, from the bottom up, he might be more interested, and able, to operate at a higher level on the needs hierarchy. Otherwise, he simply can’t. He has to meet his basic needs first.
So, when we talk to women about the empowerment of natural birthing, they are confused. Sometimes they’re angry, but they may not be sure why. I believe it is because there is cognitive dissonance because on some level they know that the fear they feel is disproportionate to the actual risk. Because there is someone who doesn’t feel that same fear, it makes them question why they have it. Not consciously, of course, but if they become aware that some women can birth with dignity, comfortably, maybe painlessly, even ecstatically, and still be safe, but they believe that they must sacrifice all that for safety, it suggests that their suffering was for nothing. That’s not a comforting idea. It would make me angry too.
This brings us to the question of how we can help them meet their needs so they can feel the ecstasy and empowerment we know is so transformative. Right now they don’t even care about that. You don’t know what you’re missing if you’ve never had it. You won’t even try for it if you don’t believe it’s really possible for you. Can you see how bubbling over with enthusiasm about your positively transformational birth experience comes across as lunacy to someone who is convinced they “would have died” if they’d done what you did? It doesn’t matter if it’s true or not, it’s what they believe.
It doesn’t matter if they had an epidural that caused a sudden drop in blood pressure, that caused fetal distress that required a cesarean that saved their life. The only part of that equation that is important is the last part. It doesn’t matter that the medical management of their birth lead to the problem in the first place. What matters is the medical management saved their life…and it did.
It doesn’t matter that they almost died of hemorrhage due to an elective cesarean, what matters is that modern medicine saved their life. Undoubtedly it did.
It doesn’t matter that their baby almost died from a cord prolapse that coincidently happened just after artificially rupturing the membranes. What matters is that modern medicine saved their baby from certain death. It did.
And because they are operating at that place of survival, it makes sense that is what they would focus on, it’s what’s important. They aren’t even going to question it unless they are operating from the 4th level. If they are, they are going to wonder how things got so askew. Many do. These are the women who have a couple of horrible experiences and then come to a HypnoBirthing class. Or, the women who hire CNM for VBACs after questionable cesareans. Or, the woman who has seen several of her friends suffer from birth-related PTSD who decides to explore the option of homebirth. No one is right or wrong; they are just making decisions based on their individual needs as they perceive them based on their own experience and beliefs.
It's a theory anyway.
My name is Kim Wildner. I am the author of Mother's Intention: How Belief Shapes Birth.