Choosing a childbirth educator
By Henci Goer
Taken from http://www.parentsplace.com/print/0,,228828,00.html

Perhaps the most important decision you will make after choosing your midwife or doctor and the place of birth is selecting your childbirth educator. She will almost certainly be your primary source of information on how to cope with labor. She can -- and should -- help you have a healthy pregnancy and complication-free labor, make informed choices about your care, have a smooth transition into parenthood, and breastfeed successfully. Childbirth educators can also guide you to other resources such as books and Web sites and can refer you to childbirth-related services, as, for example, labor support providers (labor doulas), postpartum home help (postpartum doulas), or lactation consultants. You can see why you want to consider carefully whom you choose.

What should you look for in childbirth preparation classes?

  • Independent educator: Most commonly, childbirth preparation classes are taught through hospitals, but hospital or clinic-based classes have a strong potential drawback: conflict of interest. It is in the hospital’s and obstetric staff’s interests to have patients who will comply with policies and not make waves by questioning or refusing them. Unfortunately, medical research has shown many aspects of typical, routine obstetric management to be neither safe nor effective. Hospitals may give their educators complete freedom to teach as the educator sees fit, or they may not, in which case, you won’t learn about these. As the authors of “A Good Birth, A Safe Birth” observe, “If you don’t know your options, you don’t have any.” You may also not get an objective picture of pain relief during labor. Labor epidurals generate significant revenue and subsidize having obstetric anesthesiologists available 24/7 to deal with the rare emergency. Hospital-based educators are often told not to discuss the potential problems with epidurals. You may decide for yourself that the benefits of an epidural outweigh the possible problems, but you should have the opportunity to make an informed decision.
  • Certified educator: Certification by a national organization doesn’t guarantee excellence, but it does ensure that the educator has had special training and has met some set of criteria for knowledge and skills. Many hospitals simply have their nurses teach classes, but having a nursing degree does not qualify you in and of itself to teach childbirth preparation classes.

     

  • Sufficient time to cover the topics: Fewer classes in the series and fewer hours per class both increases profits and meets the approval of busy, tired, expectant couples. However, it takes time to learn new skills, get questions answered, and explore issues. Lamaze International recommends at least twelve instructional hours per series. Based on my experience as a certified Lamaze teacher, I think 15 hours is the minimum for a thorough, first-birth, childbirth preparation series.

     

  • Small classes: Childbirth classes should be interactive. You want classes that are big enough for a good group process yet small enough for you to get individual attention and assistance and where you won’t feel shy speaking on intimate or sensitive topics. Lamaze International says that six to ten couples is ideal and sets a maximum of twelve couples.

 

What are some methods of childbirth education?

  • Lamaze: Because “Lamaze” has become a generic term for childbirth preparation classes, it is important to make sure that a “Lamaze” class is, in fact, taught by a teacher certified by Lamaze International. The Lamaze mission is “to promote normal, natural, healthy and fulfilling childbirth experiences for women and their families through education, advocacy and reform.” Lamaze has become known for the “breathing,” but focusing on the breath and using breathing patterns is only one of many tools for coping with labor that is taught in Lamaze classes. In addition to relaxation and comfort measures, Lamaze classes cover normal labor and birth, labor and birth options, strategies to facilitate good progress, and communications skills. They provide information on medical procedures and pain medications to help couples make informed choices. Most educators also cover breastfeeding, postpartum and newborn issues, and adjusting to parenthood. While Lamaze is known almost exclusively for preparation for hospital birth, the Lamaze philosophy of birth explicitly supports birth in birth centers and homes.

     

  • Bradley Method of Natural Childbirth: Among other things, Bradley classes focus on good pregnancy nutrition, natural childbirth, the husband as labor coach, no separation of healthy babies from mothers, and breastfeeding. Women are taught to cope with labor by relaxation, natural breathing, and tuning in to the body. Bradley classes encourage parents to take responsibility for decisions and advocate consumerism and positive communications, as well as being prepared for the unexpected, such as emergency childbirth and cesarean section. The series consists of twelve classes, the first few taken in early pregnancy followed by birth preparation classes beginning in the sixth month.

     

  • International Childbirth Education Association (ICEA): ICEA’s motto is “Freedom of choice based on knowledge of alternatives,” and its philosophy is based on the principles of family-centered maternity care. Family-centered maternity care is care that achieves the best possible health outcomes for all family members. Family-centered maternity care treats childbirth as a life event, not a medical procedure. It recognizes the importance of family relationships and respects the woman’s individuality and autonomy. The goal of ICEA’s certification program is to produce educators who have the necessary knowledge and skills to help expectant couples prepare mentally and physically for childbirth. ICEA educators advocate for the natural process of childbirth and the right of parents to make informed choices about their care.

     

  • BirthWorks: BirthWorks begins with the premise that women need to develop confidence in their ability to give birth and to allow themselves to be guided by that inner knowledge. There is no “right” way to give birth; each birth experience is unique. BirthWorks believes that while cesarean sections are necessary at times, the current rate is too high and that vaginal birth after cesarean is preferable to planned repeat cesarean in most cases. BirthWorks classes encourage women to choose a place of birth in which they will feel secure, which may be the home or a birth center. BirthWorks also encourages women to participate actively in decisions made about their care. BirthWorks classes begin preferably in early pregnancy or may be started even before pregnancy. This is so that women can become aware of beliefs that influence decisions about caregiver and birth place, learn how to communicate effectively with caregivers, and learn about good nutrition in pregnancy.

     

  • Association of Childbirth Educators and Labor Assistants (ALACE): ALACE "seeks to help all women experience birth’s transforming power with dignity, in safety, support, and confidence." To that end, ALACE educators work to increase trust in the natural birth process and teach students how to cope with the pain of labor. They also provide the information needed to make informed choices and avoid unnecessary interventions, in particular, cesarean section. ALACE educators prepare women for birth at home and in birth centers, as well as hospitals.

     

  • Birthing from Within: "The profound mystery and spirituality of birth can never be understood with the mind; they are known through the heart." This statement from the Birthing from Within Web site sums up their approach: Birthing from Within instructors are called "mentors," not "instructors" or "educators," to emphasize that women don’t need teaching so much as they need the opportunity to discover their own strengths and wisdom. Birthing from Within classes include practical information, but they also use multisensory exercises -- art, singing lullabies -- and introspection to explore personal and cultural beliefs about labor and labor pain. Pam England and Rob Horowitz’s book of the same title is a wonderful resource on its own as well as an introduction to this childbirth preparation method.

Note: Many childbirth instructors incorporate concepts, techniques, and strategies from various methods, including from disciplines not strictly related to childbirth such as acupressure, hypnosis, or communications skills.

What questions should you ask a prospective educator?

The qualities of the individual educator, and the fit between her philosophy and style and yours, matters far more than which school of childbirth preparation she trained in. For this reason, it is best to interview her before signing up. With hospital-based classes, or in other situations where you don’t contact the teacher directly, you have a couple of options. The intermediary person can give you an email address or telephone number. If the policy is not to give out telephone numbers, leave yours and ask that the educator call you.

  • Are you certified by a national organization? Which one? What is your background and training specific to childbirth education?
  • What topics does the class cover?
  • What are your overall goals for your students?
  • What is your opinion of ______ (or) how do you feel about _____? (Insert anything about which you have a strong opinion.)
  • What is your approach to teaching about pain relief medications?
  • Do you attend births? Working with laboring women will almost always make class content more practical and relevant. You may also wish to hire your instructor as a doula (trained labor support person).