Cutting Class

Today's pregnant women are ditching childbirth education courses in droves. Is this smart?

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I wish I'd saved the money," says Stephanie Dolgoff, referring to the labor-preparation class she attended before delivering twins by C-section.

Dolgoff, who lives in New York City, is not alone in her disappointment. Once a rite of passage for women approaching their due dates, birthing classes have lost their luster; these days, women are more likely to learn about childbirth from the media. According to a recent survey, 68 percent of first-time moms had watched reality TV shows depicting birth, compared with 56 percent who'd attended a course. Marjie Hathaway, co-director of the American Academy of Husband-Coached Childbirth (aka the Bradley Method), acknowledges the trend. "Today, women are more focused on prenatal testing and monitoring the pregnancy than in learning how to give birth," she says.

"Fewer women are taking classes," agrees Jeannette Crenshaw, RN, LCCE, president of Lamaze International and clinical-faculty member at Texas Health Resources. One reason for the lower attendance is diminished interest in nonmedicated birth. "Many women no longer trust they can deliver without epidurals and other medical interventions," says Crenshaw, noting that TV shows often depict birth as a dangerous event, even for low-risk women. While information on birthing is widely available online and in books, it's not always accurate, she adds. And expectant parents may view childbirth education as unnecessary or inconvenient, partly because of the classes' inconsistent quality and their own busy schedules.

Research shows little difference in pain, labor interventions or birth outcomes between women who take childbirth classes and those who don't, but enrollees tend to be more successful at quitting smoking, keeping prenatal appointments and breastfeeding. And women who've found a good class often say it made all the difference during labor. Jennie Dunham of North Salem, N.Y., praises her Bradley course, which she says laid the groundwork for two joyful deliveries achieved without pain medication. "I didn't need to avoid the labor pain," she says. "I needed to learn the skills to cope with it."

The Evolution Of Childbirth Ed

"Prepared childbirth" was inspired by British obstetrician Grantly Dick-Read, whose 1944 book, Childbirth Without Fear, advocated education and relaxation to overcome the "fear-tension-pain syndrome" of labor. French obstetrician Fernand Lamaze, whose strategies for "painless childbirth" included focused breathing, was hugely influential in the U.S.; by the '70s, "Lamaze" had become shorthand for such classes.

But as medical intervention during labor has become more commonplace, labor prep has morphed, especially in generic, hospital-based classes. Teachers employed by hospitals often cut back on instructing women in breathing and other self-help coping techniques, replacing them with a rundown of the institution's procedures and a tour of the delivery room. Cara Drinan of Alexandria, Va., took a one-day, 9-to-5 course offered by a hospital but didn't think it was useful. "The teacher, a nurse, walked us through the stages of labor and showed videos of different kinds of births," she says. "She tried to teach breathing, but the class was so abbreviated. It was a lot to cover in a short time."

Knowledge Is Power

Ironically, the more birth becomes medicalized, the more important it is to take a good class. "Everyone thinks they've prepared well, and the doctor or midwife will give you a song and dance about having the delivery you want," says Dunham, who was induced with her first baby. "But labor is notoriously variable, and situations arise that require decisions." That's where you reap the dividends of having had a teacher who explained each possible intervention and showed you how to be your own advocate.

"Most women would attend classes if they knew labor preparation is not about teaching women to 'breathe,'" Crenshaw maintains. "It's about building confidence, exploring birth options and making informed decisions that contribute to a satisfying labor and delivery." For example, surveys have found that most women who receive epidurals are not properly informed of the risks, she says. "It's easy to choose something if you think it will decrease pain but has no consequences," Crenshaw explains.

While there's no perfect labor-prep class, it's worth looking for one that answers your needs and suits your personality (see "Labor-Prep Schools," next page). If you're highly anxious, you might consider HypnoBirthing. If you're interested in learning as much as you can about the birthing process, you might prefer to study with a Lamaze or a Bradley teacher. Or, like Cara Drinan, you may want to hedge your bets. "I didn't put all my chips on the class," she says. "I'd already hired a doula."

Labor-Prep Schools

Childbirth classes vary dramatically in philosophy and teachers' qualifications. A good class describes the stages of labor, offers information about natural and pharmacological pain relief and covers childbirth's many contingencies. Here are the best-known programs, each of which certifies its teachers:

Lamaze builds confidence in your ability to deliver without nonessential medical interventions and teaches you to cope with pain in ways that facilitate labor. Classes offer scientific, evidence-based information to help you make choices with knowledge of the risks and benefits, no matter how labor goes. Average length: six two-hour classes. * Best for women who are open-minded about the various birthing options. lamaze.org.

Husband-coached childbirth, or the Bradley Method, promotes natural birth and claims that 90 percent of Bradley students who deliver vaginally choose not to use pain meds. Length: 12 two-hour, weekly classes. "Childbirth is an athletic event," says Marjie Hathaway, co-director of the American Academy of Husband-Coached Childbirth. "There's no sport you'd train for in less than 12 weeks." * Best for women who are already intent on natural birth but beneficial to all. bradleybirth.com.

HypnoBirthing, or the Mongan Method, teaches self-hypnosis, guided imagery and breathing techniques to bring about a nonmedicated birth. "HypnoBirthing helps women connect with their natural birthing instincts, which have been lost because of negative programming," says founder Marie F. Mongan. Length: five 2 1/2-hour classes. * Valuable even if you're not sure you want to go natural. hypnobirthing.com.

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