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Childbirth education: what are the options?

by Connie Banack CCCE, CLA, CPD

In this new millennium of incredible choices, it is no wonder that there is also an array of choices of which childbirth education classes are the best for you and your partner. There are at least ten certifying organizations for childbirth educators and each has a unique approach to childbirth. From the strict patterned breathing techniques and outward focusing taught in the past by ASPO/Lamaze instructors to the inward-focusing Bradley Method, all are as individual as each pregnant woman. Finding the best class is a combination of which technique will work best for you and your comfort level with your instructor and your classmates. In the beginning of "natural childbirth" classes in the 1930's Dr.Grantly Dick-Read gained his insights from watching middle class working patients give birth without help from drugs. He also worked in Africa, where he observed women giving birth on their own in rural villages. He saw the spiritual dimensions of birth and wrote of women's innate capacity to give birth successfully on their own and without medication. From his experiences he taught women to trust their bodies, using slow deep-breathing techniques to help cope with labour pain. His classes never caught on in popularity in North America, but are the basis of many programs today. 

During the same time, Dr. Lamaze was working in obstetrics and found the Pavlov experiments fascinating. He deducted that distraction during labour through patterned breathing techniques and using focal points would help women have pain free labours. Through his work he found this to be true if the labouring mother did the focusing and breathing effectively, having learned and practiced prior to labour. Today Lamaze has changed to incorporate deeper breathing techniques. Lamaze classes are primarily taught through hospitals or health units.

The International Childbirth Education Association (ICEA), founded in 1960, pushed ASPO/Lamaze to the left of centre. With noties to the health-care system, ICEA has always been eclectic in its approach to birth in which they incorporate sociology, anthropology and midwifery as well as nursing and medicine. ICEA was the first national organization to focus on the psychological aspects of birth. ICEA-certified educators have largely replaced Lamaze educators in many of the hospitals and health units even though they are still commonly referred to as "Lamaze classes."

A different approach was from Dr.Bradley and his "Husband-Coached Childbirth" philosophy which originated from his observation that women coped better and had better birth experiences when their husbands were present. He also found that the father-infant bond developed faster with the father present during birth. The Bradley method is now well known and it has played a very important role in allowing fathers into the hospital birthing rooms.

During the 1970's a second wave of childbirth organizations came into being in North America and Britain. This second generation focused on alternatives to standard medical and hospital procedures and practices. Among them the National Association of Parents and Professionals for Safe Alternatives in Childbirth (NAPSAC) founded by a couple in North Carolina, challenged the assumption that a hospital was the best place for birth. Rahima Baldwin, a Michigan midwife, founded Informed Homebirth in 1977, which is now the Association for Labor Assistants and Childbirth Educators (ALACE, pronounced Alice). ALACE trains both Labor Assistants (commonly called doulas) and Childbirth Educators who "teach relaxation and coping tools to work with pain and discomfort. We respect birth as an intimate act and a creative expression of love. We respect obstetric procedures as beneficial in some circumstances but potentially detrimental when applied routinely. Our goal is to help women reclaim trust in their ability to safely and dependably give birth."

The rising cesarean rate in the US brought about several women-founded organizations focusing on grassroots education for cesarean prevention. One of these, the Cesarean Prevention Movement, now the International Cesarean Awareness Network (ICAN), brought about another form of childbirth education known as Birth Works. Suzanne Arms explains in Immaculate Deception, "This teacher training program focuses on prevention of unnecessary cesareans and increasing the number of women having vaginal births after having cesareans. The underlying premise is that women innately know how to give birth successfully; they need to rediscover their bodies' wisdom and learn how to listen to their bodies. The approach is psychological as well as physiological and the teachings of a number of prominent authors in the childbirth movement have been drawn upon to create a holistic approach."

One of the newest organizations, formed to fill a need to increase professionalism and accountability within the childbirth education, labour doula, and postpartum doula professions, is the Childbirth And Postpartum Professional Association (CAPPA) and CAPPA Canada. Their focus is in providing women and their partners with the tools they need to birth as they choose, with true informed consent. CAPPA's educators strive to not involve guilt but rather empower women to choose the kind of birth that is best for them, be it medicated or un-medicated, intervention-free or full of traditional interventions. Their belief is that, given the facts, more women would choose a natural birth for themselves and their babies.

Two colleges in Canada also provide Childbirth Educator training through their continuing education or nursing programs: Douglas College in Vancouver and Humber College in Ontario. Their in-depth, two-year programs provide a solid background of knowledge about all aspects of pregnancy and childbirth. On a different note, Christian Childbirth Education certification can be obtained through Apple Tree Family Ministries and Titus 2 Birthing, both having a strong biblical basis in their beliefs and training.

Today Lamaze- and ICEA-certified childbirth educators make up the majority of certified educators in Canada due to their ability to fit well into the current medical system's beliefs. Their educators are comprised mostly of nurses and hospital-based or health-unit-based educators. Independent educators commonly choose certification from the newer organizations based on their own beliefs and experiences. Currently only CAPPA Canada and the above colleges provide certification specific to Canadians.

With the array of choices available to women, choosing a compatible prenatal class series can be both challenging and exciting. When you decide to attend prenatal classes, you should choose your teacher carefully. Besides professional considerations, you will want to find out if the teacher has values compatible with your own and personal qualities you desire. When choosing classes, answers to the following questions will help you find the right one.

Interview questions

Courtesy of www.canadiandoulas.com

What type of birth experience do I want?

Do I want the course to be woman centred? couple centred? family centred?

Will my partner attend every class?

May my children attend?

At what stage of pregnancy would we like to attend?

What does the course include?

    • Overview of the stages of pregnancy (physical and psychological aspects)
    • Diet and nutritional information
    • Information about breastfeeding and preparation for breastfeeding during pregnancy
    • Exercise including pelvic floor exercises
    • A tour of the hospital
    • Overview of typical labour and birth
    • Instruction and practice in coping techniques (breathing, relaxation, visualization, etc.) for labour and birth
    • Preparation for the partner and/or children who will be present for the labour and birth
    • Information about variations and complications during labour and birth
    • Information about possible medical interventions and options during labour and birth
    • Education re: newborn care, postpartum recovery

Format:

    • lectures
    • a support group
    • audio-visual presentations
    • discussions
    • tours
    • practice sessions
    • recommended resources

What are the instructor's credentials?

Does the instructor appear to be well informed?

Does the instructor appear to be well prepared to deliver the information?

What are the instructor's values regarding pregnancy and birth?

Are they compatible with your own?

Does the instructor encourage a non-threatening environment that allows honest discussion of feelings and attitudes toward pregnancy and childbirth?

Where are the classes taught?

How many sessions are included in the course?

How many people will attend the course?

How much will it cost?

For more information:

Lamaze http://www.lamaze.org/

Bradley Method www.bradleybirth.com

ICEA www.icea.org

ALACE www.alace.org

ICAN www.ican-online.org

Birth Works www.birthworks.org

CAPPA www.cappa.net

CAPPA Canada www.cappacanada.ca

Douglas College www.douglas.bc.ca

Humber College of Applied Arts and Technology www.humberc.on.ca

Apple Tree Family Ministries www.geocities.com/Heartland/Hills/4150/atfm/ATFM.html

Titus 2 Birthing www.geocities.com/titus2birthing/Opdocs.html

Connie has been an ALACE-certified labour assistant for 5 years, a CAPPA-certified labour doula, postpartum doula and childbirth educator. She is an approved CAPPA labour doula trainer, postpartum doula trainer and childbirth educator trainer. Connie is also the president of ICAN and owner of Mother Care (www.mother-care.ca). She currently lives in Lloydminster, AB, is married and mom to three sons aged two through ten.