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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Apr 12
    2010

    Research to support childbirth education classes

    Archived User

    I wondered if you might be able to steer me towards some good research to

    support prenatal classes. Often it seems that peers and management look at labour stats,

    i.e. epidural rates, to refute the use of childbirth classes.

    Thank you,

    Melanie

    Henci Goer

    Unfortunately, I doubt that there is a body of good research, although you might try running your own searches on PubMed. Researching the effect of childbirth education is highly problematic by nature. Observational studies won't get you anywhere because classes vary in content and teaching style even among educators certified by the same organization. Moreover, couples who sign up for classes tend to self-select into classes according to their own viewpoints, which brings me to the problem with judging effectiveness by labor stats. For one thing, if a highly motivated couple seeks out a class with a teacher or method known to promote natural childbirth, would low epidural rates be attributable to the class or the prior intent of the couple? For another, the woman's care provider's and hospital's policies and practices will almost certainly overpower whatever the couple learns in their classes. Who, after all, are they going to believe: the trained experts or her educator, especially when they, as my Aussie friends call it, start "waving the shroud"? In fact, classes sponsored by a hospital or clinic  where conventional obstetric management is the norm--and this would be the majority--would hardly encourage informed decision making. Any teacher who tried it wouldn't do it for long. A randomized controlled trial might tell us something useful, but RCTs are complex and expensive to mount. You would need an institution to back it, which circles back to the issue of the previous sentence, not to mention what would be the payoff for spending the time and money needed to carry it out? 

    In an ideal world, we wouldn't need childbirth education classes. Care providers would assist women in making informed choices by giving them complete, accurate, unbiased information about their options and providing them optimal care in labor (the least use of intervention for any given individual that produces the best outcomes). All women would labor under the guidance of caregivers and in environments that foster the natural unfolding of the process, including access to a wide range of comfort measures and pain coping strategies besides epidural analgesia. Ironically, the reason classes are needed is to help women cope with a system that is all too often "none of the above." 

    I'll step down off my soapbox now. Anyway, for a perspective on what role childbirth education could play in maternity reform, see this Science&Sensibility blog post.

    -- Henci

    Archived User

    In light of the fact that there is no research to support childbirth Education Classes, how does doe someone such as myself attempt to teach in the hospitals here in Trinidad and Tobago. I applied to teach CBE classes and was told that I need to "sell the idea to the doctors" first before I could even think of teaching. Trinidad and Tobago's birthing community is dominated by old school male doctors, informed choice almost does not exist, fathers are not allowed in the birthing room unless they attend CBE classes at the hospital (and they still may not be allowed in for the birth), we have the second highest infant mortality rate Hattie being the first and people hardly attend childbirth classes. My question is with little to no research how do I show the benefits of CBE classes to these doctors?...what is the best approach is.

    Shantelle Sandiford CLD,CCCE

    Doula & Childbirth Educator Trainer

    Henci Goer

    First, let me apologize for taking so long to get back to you. I was working on a project with a hard deadline, but I have finished it at last. As foar as I know, we don't have evidence that the more typical model of a certain number of weeks of childbirth education either improves outcomes or reduces cesarean rates. We do have evidence, however, for the benefits of a model of care that incorporates education with prenatal care, including a randomized controlled trial that reported a reduction in preterm birth rates. The significant thing about this model is that it has its strongest effects in disadvantaged women. You can find out more about it here. This page of the website has the research. Perhaps you could adapt the model in a way that would work in your community.

    ~ Henci 


    All Times America/New_York

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