Wednesday, October 15, 2014

Why You Need a Childbirth Class

I spend an awful lot of time talking to women about birth.  I am endlessly fascinated by birth, and I love listening to others tell their stories.  In all honesty, I'm kind of a junkie when it comes to birth.  Everyone's experiences with pregnancy, labor, and birth are so different, and I have heard stories from all across the board.

Here's a comment I come across sometimes:  "Why do I even need to take a childbirth education class?  I've read a few books.  Won't my doctor tell me everything I need to know?"  Sadly, the answer to that is a resounding NO.  Reading is fantastic, and you can prepare yourself pretty well that way, but a good childbirth class can fill in the gaps and truly prepare you to have the amazing birth you want to have.  And as much as we want to believe that our care providers will educate us, the fact remains that you are only one of their patients, and their time is limited; even if they want to teach you all they know, they just don't have time.  And many care providers, unfortunately, would be happier if you just did everything they said without question.

You are doing yourself a great service by taking a childbirth class!  Educating yourself is never a waste of time, and will hopefully help you to have the birth you want.

Here are some other things I have heard:
"My doctor decided to induce me.  I didn't want to be induced, but I didn't think I was allowed to say no."
In an ideal world, your caregiver would give you the facts about your & baby's condition, give you the benefits and risks of all options available to you, and offer their professional opinion about the course you should take.  You could than use this information to make an informed decision about your care, and your caregiver would respect that decision, even if it was not their recommendation.  Unfortunately, we do not live in an ideal world.  Chances are good that your caregiver knows a whole lot more about pregnancy and birth than you do.  But chances are also good that they are considering factors beyond their own experience and your best interest when they make their recommendation.  You do have options, and your caregiver's word is not law.  Informed consent means knowing both benefits and risks for any procedure, and it includes the right of informed refusal.  And a good childbirth class will teach you about risks and benefits of interventions before labor even begins, so that you don't have to distract yourself from the important work your body is doing by trying to learn new information on the spot.  This enables you to make truly informed decisions regarding your care.
"After how hard the last labor was, we decided to just schedule a repeat c-section."
I obviously can't comment on the last labor, since I was not there and I do not know the full story or why baby was ultimately born via cesarean.  However, the fact remains that every labor is different.  Just because the last one was difficult does not mean that this one will be.  VBAC is safe, and in many cases it is safer than a repeat cesarean.  Labor is hard work, but it is worthwhile and you CAN do it.  A good childbirth class will cover VBAC, and will give you the information you need to achieve your birth wishes.
"They want to induce me at 39 weeks.  When I asked why, they said, 'It's just what we do.'"
Like everyone else who works in the birth world, I do not take issue with induction if there is a valid medical reason.  But there is something troubling about a caregiver who wants to take such a drastic step without providing any reason at all.  Early induction increases the likelihood of your baby needing a stay in the NICU; every day that your baby stays in the womb is beneficial for growth.  Early induction could be the start of the slippery slope known as the "cascade of interventions," and if induction fails because your baby and your body just aren't ready, there is a good chance you will end up with a cesarean.  A good childbirth class will help give you the confidence to stand up for yourself, and to demand legitimate answers to reasonable questions.
"After they gave me my epidural, they broke my water.  I didn't even know they had done it until one of the nurses casually mentioned it later."
Hearing things like this just drives me crazy, but it is shockingly common.  For some caregivers and hospitals, breaking a woman's waters (the technical term is artificial rupture of membranes, or AROM) is such a standard procedure that the doctor doesn't even feel the need to mention it to the mother.  This is just one of many reasons why it is so important to have a good labor support team, whether it is your partner, family members, a good friend, or a doula.  Your support people will know what you want out of your labor; if you've requested no routine AROM and they see your OB heading your way with an amniohook, they can tell you before it's too late.  A good childbirth class will talk about your personal labor support team, including doulas; your teacher will likely even know a few if you are interested in recommendations!
"I hadn't done any research on epidurals before going to the hospital; I had no idea I'd need a catheter!  I'm just glad my husband knew enough to explain things to me, because the nurse wasn't helpful at all."
Wouldn't it be nice if your doctor/midwife/nurse took the time to explain these things ahead of time?  Unfortunately, that's usually not the case.  Most caregivers recommend some sort of childbirth class during pregnancy (and even OBs will usually recommend at least the class offered at the hospital where you are giving birth).  The fact of the matter is that you cannot depend on your caregivers to provide you with all of the information you need, but a good childbirth class will.
"My doctor induced me a few days after my due date.  He said going post-date put my baby at risk."
This touches on two things:
  • The "safest for baby" card: Naturally, no mother wants to put her baby at risk.  But using it as a tactic to scare a mother into what might otherwise be an unnecessary induction is just wrong.
  • Definition of post-date: The above quote is just flat-out inaccurate.  Recent studies have indicated that the length of a healthy, term pregnancy can vary by as much as five weeks, and even ACOG (the American College of Obstetricians and Gynecologists) recognizes that post-term is a baby born 42 weeks or later.  (Read about their recent statement regarding new definitions of term pregnancy.)
Sometimes, there is a good reason to induce around your due date.  Other times, there is no harm in letting baby stay put for awhile longer.  A good childbirth class will discuss what you may be faced with if you go past your due date, and will help you to understand when to let nature take its course and when to consider intervening.
"When I got to the hospital, I was in very early labor.  But I live 45 minutes away, so they didn't want to send me home.  Instead, they broke my water to 'get things moving.'"
The woman who I heard this from gave birth more than thirty years ago, but I've heard similar statements from friends who have given birth more recently too.  Nowadays, if they don't just send you home for coming in that early, you'll probably end up with Pitocin or some other form of augmentation.  (And that's not even getting into the discomfort of several trips to and from the hospital and how it can potentially slow down labor, or the emotional upheaval that many women experience upon finding out that they have a long way to go!)  A better idea would be to find a nearby park and go for a walk; if you live really far away from the place where you will be giving birth, you might even consider renting a nice hotel room for early labor.  It's important to remember that in many hospitals, once you have been checked in you are "on the clock."  Many hospitals place rather arbitrary limits on how long a woman can be in labor for, and as you near that time limit they may start pressuring you to accept interventions that you do not want.  And if your waters are broken (or they do it for you), you are even more likely to face time limits.  AROM brings its own set of risks: there is an increased risk of cord prolapse, especially if done early in labor, and there is an increased risk of infection (a risk which rises further with each vaginal exam you receive).  Routine early AROM hasn't been shown to provide very many benefits either; the hospital is not likely to go over the risks and benefits with you in detail before the procedure, but a good childbirth class will!  A good childbirth class will also help you know when is the best time to travel to your birth place (or when to call your midwife over if you're birthing at home).

Please do yourself (and your baby) a favor and take a good childbirth class!  You will learn things you didn't even realize you needed to know, and the knowledge you gain will ultimately help you to have the birth you want.

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