Childbirth Education

Definition

Childbirth education prepares the mother and usually her partner for labor and birth. It may also include information on cesarian birth, breastfeeding, maternal postpartum issues, and neonatal care. Special classes may be available for adolescent mothers, vaginal birth after cesarian birth, siblings, and grandparents. Classes may consist of lectures, slides, videos, demonstration and practice.

Description

Based on the goals of the facility or instructor, childbirth education classes can vary considerably in terms of content. For example, some classes may focus primarily on the childbirth process, while others provide information on wellness behaviors during the different trimesters of pregnancy. Classes offered by some facilities may not include information on postpartum contraceptive choices. Some classes provide information on fetal growth and development and maternal changes during pregnancy. These classes are usually offered earlier in a woman's pregnancy, while classes that focus primarily on labor and delivery are offered later. Some obstetric practices may provide gestational information at each prenatal visit; others may focus primarily on the mother's questions or concerns. Some practices may offer classes that complement the information given during prenatal visits or they may have on hand a list of classes that pregnant women may want to contact.

Questions to consider when making a birth plan

How have you tried to prepare yourself for labor? How has your partner or support person been involved?

What do you think labor will be like?

How much pain do you think you will have in labor? Why do you think it will be like that?

Do you want pain medications, or do you want to avoid them? Which pain medications would you prefer?

How long do you think your labor will last? Why do you think it will be that long?

Which support people will be with you during labor? How is each related to you?

Who is welcome to be at the birth?

What do you want your support person to do for you when you are in labor?

What is most scary to you about being in labor and giving birth?

What is most important to you about this birth?

How do you feel about:

monitoring the baby during labor?

mobility during labor?

positions during labor?

an IV?

having your bag of water broken?

using breathing and relaxation techniques to help you through the contractions?

medication to relieve pain during labor?

an epidural anesthetic to take away the pain of labor?

episiotomy procedure?

If a cesarean becomes necessary, do you have any special requests?

If the birth is planned at home or at a birth center, what are your plans in case of transport?

What are your preferences for baby care, feeding, and rooming?

If you had a baby before, did anything happen that might affect you during labor this time?

source: Wheeler, L. Nurse-Midwifery Handbook: A Practical Guide to Prenatal and Postpartum Care. Philadelphia: Lippincott-Raven Pub., 1997.

Content areas that may be included in childbirth education classes are:

• maternal changes in early pregnancy: physical and emotional
• fetal growth and development
• risks of certain environmental factors on fetal development
• maternal self-care: nutrition, rest, exercise, work accommodations

• common discomforts in pregnancy and safe/unsafe relief measures
• sexuality and pregnancy
• signs and symptoms of complications of pregnancy
• signs of preterm labor
• signs of the initiation of labor
• symptoms that require a call to the obstetric provider
• what to expect during labor and delivery
• labor and delivery analgesia/anesthesia options
• breathing and relaxation techniques
• role of certified nurse midwife versus obstetrician
• role of the coach
• making a birth plan; hiring a doula
• episiotomy issues
• breastfeeding versus formula
• breastfeeding techniques, normal/abnormal problems, and relief measures
• neonatal care and safety issues
• postpartum contraception
• tour of labor and delivery area of affiliated health care center

Viewpoints

Childbirth education classes are offered based on the premise that knowledge about what to expect during labor and delivery prepares a woman for the process. For example, fear of the unknown is associated with increased pain and muscle tension. Childbirth classes traditionally teach breathing and relaxation techniques for women to use during labor and delivery. It is believed that these techniques enable the mother to better manage the pain of childbirth, feel more in control, have a better birth experience, and bond more readily with her newborn. Some childbirth classes promote a particular method and philosophy, such as the Lamaze and the Bradley methods.

The Lamaze method is supported by the American Society for Psychoprophylaxis in Obstetrics (ASPO) and was popularized by the French physician Ferdinand Lamaze. Classes focus on breathing, movement and positioning during labor, use of massage and relaxation techniques, the role of labor support, use of heat and cold, and water therapy. The ASPO/Lamaze philosophy is:

• Birth is normal, natural, and healthy.
• The birth experience profoundly affects women and their families.
• Women's inner wisdom guides them through birth.
• Women's confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth.
• Women have the right to give birth free from routine medical interventions.
• Birth can safely take place in birth centers and homes.
• Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health, and to trust their inner wisdom.

The Bradley method was designed by Robert Bradley, an obstetrician. During the 12 sessions, Bradley classes emphasize a special pregnancy diet, maternal changes during pregnancy, the coach's role, special coaching techniques, the importance of natural childbirth, sex during pregnancy, the first, second, and third stages of labor, pushing during labor, making a birth plan, labor rehearsal, postpartum information, breastfeeding, and newborn care. The Bradley method's goals are:

• natural childbirth
• active participation of the husband coach
• excellent nutrition as the foundation of a healthy pregnancy
• avoidance of drugs during pregnancy, birth, and breastfeeding unless absolutely necessary
• relaxation and natural breathing
• tuning in to the body
• responsibility of parents for the safety of the birth place, procedures, attendants, and emergency backup
• immediate and continuous contact with the newborn
• initiation of breastfeeding at birth
• preparation of parents for unexpected situations such as emergency childbirth and cesarian delivery

Childbirth education classes provide information to pregnant women in an environment of their peers, where they meet with other women or couples at the same stage of pregnancy. By educating women about the childbirth process, these classes enable women to focus on their particular issues during prenatal visits, while still receiving general pregnancy and childbirth information. Issues raised during the classes allow women time to reflect on the choices they want for their birth experience. In addition, these classes often are a springboard for new groups where mothers get together postpartum with their newborns. Friendships formed during class time can help avoid the isolation sometimes existing in the postpartum period.

Professional implications

While some women benefit from choosing a particular method of childbirth education, many women prefer using a more eclectic approach. The more nurses and other health care professionals are informed of various methods, the better equipped they are to assist women to have the type of childbirth they choose. The various breathing and focusing techniques provide relief from or a decrease in pain through distraction and muscle relaxation. There are many ways to achieve these goals. It is important for nurses to provide options while allowing women to make their own choices. Taking a series of classes and doing the required homework requires time, effort, and motivation. Many women come into childbirth virtually unprepared. Labor and delivery nurses may choose to select different aspects of a variety of methods and incorporate them into their own practice.

It is helpful for office obstetric nurses to be aware of the various classes in their areas, even classes not listed by their own facility. One may be able to request permission to sit in on some classes or to view the class content list. This enables the provider to know what information, accurate or otherwise, is available to pregnant women and to address issues as needed during prenatal visits. If not provided during the classes, obstetric providers may wish to offer instruction on exercises women can do at home that will facilitate the birth process: abdominal and back exercises for strength and flexibility, Kegel (pelvic floor muscle) exercises to promote perineal healing and to counteract stress incontinence, tailor sitting and squatting to stretch perineal and pelvic floor muscles, and pelvic rocking to relieve lower backache.

Nurses also need to be culturally sensitive. While most husbands may wish to participate in the birth process, this may be an uncomfortable practice in some cultures. In addition, some men, regardless of their cultural background, may not want to participate in the birth process. The birthing woman may wish instead to have a female relative or friend as a support person. As long as a practice is medically safe, nurses need to respect the choices of the birthing woman and her family.

KEY TERMS

Doula— A doula is someone who undergoes special training to enable them to support women during childbirth and into the postpartum period.

Episiotomy— A surgical incision made to enlarge the perineal area for delivery, to avoid tearing of the tissues, especially with a large neonate or during a difficult birth. Many women request the avoidance of a routine episiotomy. To avoid performing an episiotomy, certified nurse midwives may stretch the perineum with perineal massage.

Perineum— The area encompassing the anus and the vagina.

Resources

BOOKS

Pillitteri, Adele. Maternal & Child Health Nursing: Care of the Childbearing and Childrearing Family. Philadelphia: Lippincott, 1999.

Spencer, Paula. Parenting Guide to Pregnancy & Childbirth. New York: Ballantine Books, 1998.

ORGANIZATIONS

The Bradley Method. American Academy of Husband-Coached Childbirth®. Box 5224, Sherman Oaks, CA 91413-5224. (800) 4-A-Birth. 〈http://www.bradleybirth.com〉.

International Childbirth Education Association (ICEA). P.O. Box 20048, Minneapolis, MN 55420. (952) 854-8660. 〈http://www.icea.org〉.

Lamaze International. 2025 M Street, Suite 800, Washington DC, 20036-3309. (202) 367-1128. (800) 368-4404. 〈http://www.lamazechildbirth.com〉.