By Brittany Sharpe McCollum, CCE(BWI), CD(DONA)
Childbirth is a life process, offering an unparalleled opportunity for personal growth, transformation of identity, and instinctual guidance. Commonly, people come out of their birth experiences with vivid memories of key moments occurring during the experience, moments that left them feeling particularly cared for, listened to, or verbally encouraged with just the right word. These twinkling reminders of the long-lasting impact of the labor and birth process provide an intimate look into the impact of childbirth on the overall perspective of the individual experience.
All too often, though, we hear of the other side of things, of people feeling traumatized by their birth experiences. Postpartum Support International states that Postpartum Post-Traumatic Stress Disorder (PTSD) can be caused by real or perceived trauma during delivery or postpartum and the World Health Organization has called for increased scrutiny of disrespectful childbirth practices around the world. What are the factors that make a birth experience positive even when the “birth plan” goes out the window? According to Kate Kripke, founder of the Postpartum Wellness Center of Boulder, “if at any point during [the] experience [the] sense of safety and security [feel] truly threatened, [the person] can come out of it being traumatized.” The Birth Trauma Association adds that “factors such as loss of control, loss of dignity…feelings of not being heard or the absence of informed consent to medical procedures” all contribute to feelings of PTSD. And Postpartum PTSD can affect both the person giving birth as well as the partner.
Penny Simkin, founder of DONA, states “It is clear that the birth experience has a powerful effect on [people] with a potential for permanent or long-term positive or negative impact” (Just Another Day…) Knowing this, how can laboring people and their partners develop the tools to not only understand the birth process but also to maintain a sense of control over the experience, to come out of it feeling empowered, excited, and prepared for the parenting challenges that lie ahead? One clear answer is to take an independent childbirth class.
Independent birth classes are facilitated by instructors that are not employees of a place of birth. They offer information that is usable in all birth settings and instructors, trained and certified by childbirth education organizations, are not obligated to provide information strictly in line with the policies or routines of any labor institution (which may vary greatly from one place to another and are often based on assumption of patient interests, liability for the provider, and ease of management for staff). In the episode “Childbirth Education for Pain Relief During Labor” from the podcast Evidence Based Birth, PhD nurse and founder of Evidence Based Birth, Rebecca Dekker states “Research shows that these classes tend to teach people to be critical consumers of their healthcare, and they also tend to focus on a normal birth philosophy – helping you prepare to have as normal a birth as possible.” A well constructed childbirth class will focus on providing expectant people with a toolbox of resources for communication with providers, tools for advocating for one’s birth wishes, and a solid foundation of their rights throughout the process. Rather than focusing on teaching someone the ins and outs of birthing in a specific place, an out-of-birth-place class focuses on encouraging someone to have a positive birth experience in their own terms. This means that it is not about telling someone how they should give birth but providing them with the tools to make their own decisions, develop their own priorities, and be part of the labor and birth process in whatever way feels best to them. Research has even shown links between childbirth self-eficacy (defined as as one’s belief in one’s ability to succeed, as self-defined, in specific situations) and improved parenting outcomes (Tilden).
Through discussion and shared information, one may find that they begin to develop priorities and expectations for a labor process that feels less intimidating, more manageable, and even something about which to be excited. In addition to those skills, people open to being active physically throughout their birth and avoiding or minimizing the use of medical pain relief, will develop resources, such as position and movement suggestions and relaxation techniques, that research has shown can decrease the likelihood of requesting epidurals and narcotics for pain management and shorten the amount of time spent in labor. However, childbirth education is not just for those looking to avoid pharmacological methods for pain relief. Those desiring an epidural or narcotic or nitrous oxide to assist them through labor will find that they are better equipped to make decisions with their providers and ask questions along the way to ensure that the care they are receiving is truly evidence based. The development of a usable and effective birth plan – something that can easily be aided the bounty of information provided in a birth class – can help expectant families sketch out a basic idea of what their priorities are and the steps necessary to be more confident in having those desires met.
Birth plans are often thought of as the solidifying factor for birth not going as one has planned but if a birth plan is developed in a way that allows room for flexibility, opens up communication between the client and the provider, and emphasizes active participation in the birth, it can be a fantastic tool for assisting in a positive birth experience. Many educators will encourage their clients to utilize a list of questions similar to those developed by DONA founder Penny Simkin, which are based on gathering all information necessary to consent or refuse a procedure. Reminding providers of the client’s desire to make informed decisions can be a useful part of the birth plan and can be further discussed in the class. For more information on birth plans, check out this article at A Child Grows – https://www.achildgrows.com/2017/05/24/creating-an-effective-birth-plan/.
In a society lacking support for pregnant families in exploring their options and asking questions that demand objective, rather than subjective, responses, the birth class plays an essential role. Often pregnant people are subjected to bits and pieces of birth stories from friends and strangers, sensationalized images of childbirth on television and in movies, and quick advice from well-meaning acquaintances. The birth class provides that crucial safe space for sorting through the litany of information that is acquired on a daily bass – from Hollywood, from social media, from co-workers – and a positive environment for exploration of one’s beliefs, dissection of the myths surrounding childbirth, and a contextual understanding of birth stories shared by family and friends.
Perhaps the best part of developing these tools is that they are usable in all aspects of life. The skills developed in a birth class that supports people in asking questions and understanding research-based decision making are transferable to any situation where advocacy comes into play. From prenatal visits to labor decisions to postpartum support to pediatrician appointments (as well as visits to the vet, doctor’s appointments with ailing friends or family, and confidence in breastfeeding in public, and the list could go on!), these tools help a person develop their voice, which is a tool that, once found, can never be taken away.
All of the above – the understanding of communication, knowing one’s rights, gaining knowledge of informed consent, the development of a birth plan, the exploration of resources commonly relied on for managing labor discomfort, and a shared safe space for sorting through it all – make childbirth education classes a crucial part of the preparation for a healthy birth and a peaceful transition into postpartum life. A birth class truly is a LIFE class – whether it’s discussion of alignment of the body, learning about the rights one has, or connecting with a partner in touch measures that are intimate yet not sexual – childbirth education classes have the ability to create a foundation for moving into the postpartum period feeling secure and confident in transitioning to a new life phase.
The Birth Trauma Association. Birth Trauma Association, 2018, http://www.birthtraumaassociation.org.uk/. Accessed 30 June 2018.
Dekker, Rebecca. “Positions during Labor and their Effects on Pain Relief.” Evidence Based Birth, 12 March 2018, https://evidencebasedbirth.com/positions-during-labor-and-their-effects-on-pain-relief/.
Dekker, Rebecca. “Hypnosis for Pain Relief During Labor.” Evidence Based Birth, 19 June 2018, https://evidencebasedbirth.com/hypnosis-for-pain-relief-during-labor/.
Dekker, Rebecca. “Childbirth Education for Pain Relief During Labor.” Evidence Based Birth, 30 May 2018, https://evidencebasedbirth.com/childbirth-education-for-pain-relief-during-labor/.
Hotelling, Barbara A. “The Nocebo Effect in Childbirth Classes.” The Journal of Perinatal Education, 22(2), 2013 Spring, pp. 120-124.
Pearson, Catherine. “Inside the Painful, Lonely Experience of Birth Trauma.” Huffington Post 7 June 2016.
“Postpartum Post-Traumatic Stress Disorder.” Postpartum Support International, http://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/.
“Prevention and elimination of disrespect and abuse during childbirth.” WHO, 2018, http://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childbirth-govnts-support/en/.
Simkin, Penny. The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions. Boston, MA, Harvard Common Press, 2008.
Simkin, Penny. “Just Another Day in a Woman’s Life? Women’s Long-Term Perceptions of Their First Birth Experience. Part I.” Birth, 18:4, 1991 December, pp. 203-210.
State of New York, Department of Health. Your Guide to a Healthy Birth. 2935.
Stoll, Kathrin H. and Wendy Hall. “Childbirth Education and Obstetric Interventions Among Low-Risk Canadian Women: Is There a Connection?” The Journal of Perinatal Education, 21(4), 2012 Fall, pp. 229-237.
Tilden, Ellen L., Aaron B. Caughey, Christopher S. Lee, and Cathy Emeis. “The Effect of Childbirth Self-Eficacy on Perinatal Outcomes.” Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45(4), 2016 July-August, pp. 465-480.