Authors: Kate Levett, Research Fellow University of Notre Dame Australia; Adjunct Fellow (National Institute of Complementary Medicine), Western Sydney University
Most women and their partners are offered or recommended childbirth education classes as part of routine care during pregnancy. Most first-time parents attend these classes but this declines considerably for following pregnancies, although there is no recent data about rates of attendance.
Childbirth education is often attended at the hospital where women are going to give birth, but increasingly women and their partners are seeking non-hospital, alternative classes and workshops.
So is childbirth education important? Do all the programs aim to achieve the same thing and, most importantly, do they?
Our new paper on childbirth education has shown it is possible to dramatically reduce interventions in the birthing process and help reduce parents' fear and make them feel more empowered and excited about giving birth. The program was a two-day weekend workshop for women and their partners, and was based on elements of the privately available course She Births®, and the acupuncture for labour and birth protocol.
What our study found
The study was conducted as a randomised controlled trial of an antenatal education program that aimed to reduce epidural rates in low-risk, first-time mothers.
The course included a range of evidence-based complementary therapies, such as acupressure, relaxation, massage, visualisation, yoga, and breathing techniques. We also incorporated continuous support from a partner.
The course involved an education session on the benefits of natural birth, and how women’s own hormones could be utilised or enhanced to cope with labour pain, by using the complementary therapies included in the course.
We found the women in the study group had a significant reduction in epidural rates compared with women in the control group (23.9% compared to 68.7%). They were also significantly less likely to require their labour to be sped up with artificial hormones (28.4% compared to 57.8%) or have damage to their perineum (84.7% compared to 96.4%).
They had a shorter “pushing” stage of labour (mean difference of 32 minutes), and almost half the caesarean section rate (32.5% compared to 18.2%). The babies in the study group were also less likely to require resuscitation (with oxygen or bag and mask) at birth (13.6% compared to 28.9%).
The evolution of childbirth education
Back in the 1960s, there was a push to get future parents educated about natural birth. This was because from the early 1900s, most women started going to hospitals to have their babies, and drug use for pain relief during labour started becoming more and more widespread.
This began with chloroform, well known for its use by Queen Victoria in 1853. But, over time, harms, such as women being rendered unable to move, began to be known.
Through the 1940s and 1950s, the effects of a cocktail of drugs known as “Twilight Sleep” (morphine and scopolamine) were uncovered with women finding they felt dopey and had little memory of the birth. There was a renewed push for re-education about natural birth.
The push for natural birth was based on the work of British obstetrician Grantly Dick-Read, whose work centred around the concept of childbirth without fear. This led to the natural childbirth movement started by physical therapists Elisabeth Bing and Marjorie Karmel in the United States, and obstetrician Frederick Lamaze in France, which all became known as the Lamaze movement.
Childbirth education also evolved to help empower parents make choices and be informed about birth. But while these childbirth education classes increasingly became a routine part of antenatal care in Australia during the 1970s and 1980s, by the 1990s, there was a distinct shift away from natural childbirth and towards hospital births.
These classes are now geared more towards parent education with less focus on birth, and more general information about pregnancy, birth and early parenthood, as well as about hospital routines and services.
Information for parents about birth includes descriptions of medical interventions, such as induction of labour, routine vaginal exams, artificially speeding up the labour, caesarean section, and the various options for pain relief during labour.
How is childbirth education changing?
More recently, there have been a range of private classes offered for birth preparation. Although most haven’t been evaluated for effectiveness. In the UK and Australia, trials of self-hypnosis for childbirth preparation have shown some effect in reducing anxiety in labour. But they’ve failed to demonstrate any reduction in the use of pain killers during labour, or on rates of caesarean section.
A Cochrane Review of antenatal education for childbirth or parenthood says the effects or outcomes of these programs are largely unknown, and that the outcomes they seek are as diverse as the programs offered.
High rates of medical intervention in childbirth are problematic as they often lead to what is termed a “cascade of interventions”, where the first intervention in labour leads to subsequent interventions to manage the side effects of the original one.
Research shows these interventions, which commonly begin with epidural analgesia, often result in instruments such as forceps being needed, episiotomy (where the skin between the anus and vagina is cut), major trauma to the perineum or a caesarean section.
Education about the birthing process has been found to reduce fear about labour and birth by helping parents understand the physiology of normal labour and birth, empowering couples to be invested in their own experience, and understanding what is available to support labour and birth.
Similarly, evidence-based complementary medicine techniques seem to be effective in reducing interventions in labour. Childbirth education should be re-imagined to ensure parents have the tools and positive attitudes needed to manage labour and birth.
Kate Levett receives funding from Australian Postgraduate Award. Kate Levett is a trained acupuncturist, and is a member of the Australian Traditional Medicine Society.
Hannah Dahlen receives funding from The NHMRC and ARC. Associated with the Australian College of Midwives but not paid by them