What with all the posting we did last week in the run-up to Mother's Day, I got a little behind in my updates about attending a local childbirth education class. (Actually, with so many great organizations to report on there simply wasn't room for me to fit this post in! Luckily, I've been taking extensive notes.

During the second week of class, the instructor started with a discussion about pain'using the familiar Pain-Fear-Tension diagram:

A give-and-take conversation ensued about traumatic pain versus labor pain and how the characteristics differ greatly. The class participants seemed to get it'that labor does not represent pathology.

I was heartened to hear the instructor take time out to address the culturally-driven practice of 'working up until the baby is born,' for a large percentage of American women. She linked this practice to the sustained fatigue women enter their birth experiences with, and how oxytocin production falters when a term pregnant woman's body is and has been in hyper-adrenaline-secreting mode for the previous weeks/months. Her point, about our human inability to cope well with pain, when physically and mentally exhausted, seemed to resonate with her students. Disappointingly, however, she warned the class: 'It's not going to change'society's unfavorable nature toward pregnant women and new moms. I'm not telling you to go out there with your picket signs [and try to make a change].'

Why shouldn't we be telling (suggesting) our students to 'go out there with their picket signs?' Why shouldn't we entice the people for whom the pregnancy, labor and birth experience constitutes a here-and-now situation, that unless pregnant women and their partners demand better maternity leave plans'¦that, indeed, nothing will change?

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The second half of class consisted of watching an InJoy video on the stages of labor. I seem to continually find myself engaged in a love-hate relationship with childbirth education videos. I LOVE the computer animations used to show expectant parents what's going on inside of mom's body during the labor and birth process. I LOVE that, over time, they have begun to include more and more representations of normal birth practices (in the video we viewed, we see laboring women using birth balls, bathtubs, doula support and various first and second stage positions). I LOVE the fact that each birth vignette ends with images of mother and baby breastfeeding. But there are also mishaps along the way'perhaps subtle enough that the expectant parent might not notice, but glaring enough that I continually find myself asking, 'why?' Here's what I mean:

While the video (in this class, there is a heavy reliance on information delivery via video with a breezy, summarized follow-up by the instructor) made mention of the importance of staying home in early labor, several subsequent scenes demonstrated women in the hospital who were clearly in early labor. Despite a few images of women in their homes (I guess, in early-earlylabor) the majority of the film demonstrated laboring women in the hospital setting'no birth center settings seem to have been represented. And, while I know many hospital L&D units have invested gazillions of dollars in revamping maternity wards such that they feel less clinical (with pretty cupboards hiding medical equipment, nice wall paper, jetted tubs'¦), many childbirth education videos still show rooms full of crash carts, infant warmers, IV pole stands and the like. I'm not arguing the existence of these things'one would and should expect their presence in a hospital setting, for those small-percentage-of-the-time incidences in which they are needed. But their inclusion in childbirth education videos has the subtle effect of further convincing already media-influenced expectant parents that pregnancy and birth is a medical condition to be treated.

I'm not a film maker, so I suppose my criticism must be taken with a grain of salt. There may be pressures placed upon the companies that make childbirth education films beyond that which I can imagine. All I know is, when teaching my own classes, I constantly find myself dissecting the film with my students afterward, and discussing which parts of the film helped or hurt their image of birth.

As this second class was coming to an end, questions from the students arose in response to the film. While pushing positions were reviewed in the video, a woman asked one of those time-honored questions. 'How will we know how to push?' The instructor responded to the question by assuring the class, 'we'll teach you that when you come in to deliver.' Being an L&D nurse at the same facility in which a childbirth educator is teaching may have its benefits here: the potential to follow-up with students and assist them during their labor and births provides a continuity of care different than that which an independent teacher can likely offer (unless she also practices as a doula). Still, I wondered how satisfied the student felt about this response.

A subsequent question about the quality of breastfeeding support in the hospital garnered a similar answer'affirming the presence of 25 nursing staff members who have undergone lactation support training, the instructor responded to the question with a sweeping, 'We've got you covered.'

If this post feels like a breezed-through version of the class, then it replicates the experience of the class well. Under pressure to present a ton of material in what may be a limited amount of time on the facility's Community Education calendar, the list of topics being covered seems fairly complete, but the depth of discussion feels thin.

Stay tuned later today for a review of Childbirth Education Class # Three: Comfort Measures and Medical Interventions.

Posted by: Kimmelin Hull, PA, LCCE

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