I have some questions about the future of childbirth education. My interest is partly because I worked as an independent childbirth educator before becoming a nurse and midwife. My interest is partly because I have learned about he importance of health education for public health. My interest is also partly due to the ways the internet and social media have changed access to information.
Question One: Do women see a need for childbirth education?
In a 2015 study of young women’s perceptions of future childbearing, only half the women reported they desired more information about pregnancy and childbirth.1 I can relate. When I had my first child I didn’t feel a strong need for more information about childbirth. I assumed it was a normal process and so it wouldn’t be a big deal. It never occurred to me that I would need to learn how to negotiate with a health care system that wasn’t designed to support normal, physiologic birth. I did expect to learn “techniques” to help me stay comfortable.
In the late 1990s, when I was pregnant, the internet was still a new public phenomenon. Books, magazines, and adult education classes were still important avenues of new skills and information. Today when I have questions, my first step to find answers is to check the internet. It provides me with introductory information, lists of books, and even videos that demonstrate skills. I’m not sure I would expect I needed to take a class to learn to have a natural birth if I was having my first child today.
Question Two: Are women interested in a group preparation for birth?
One of the main reasons I attended a childbirth education class was to learn how to be comfortable during a natural childbirth. By the late 1990s in the United States women were already sorting themselves into “natural” and “epidural” preparation categories. Women who planned an epidural didn’t see a need for childbirth education classes that focused on natural birth techniques. Hospitals in my community re-branded their childbirth preparation courses to be preparation for any type of birth. Still, women who planned for epidural were less interested in attending classes to prepare for birth with an epidural.
By 2012, the primary cesarean rate had increased with states reporting between 12.5 and 26.9% of births to women with no history of cesarean as a cesarean delivery. In 1997, two years before my first birth, 18% of births to low risk women were through cesarean. By 2009, 28.1% of births to low risk women were via cesarean delivery. As use of cesarean for delivery grew, did the interest in natural birth decrease? As our obstetric practice changed, did it change women’s expectations about how they should prepare for birth? By this time there was already a shift in the population, with older, more educated women attending classes while younger and less educated women did not.2
There has been a shift in public health promotion to avoid primary cesarean in low risk women, but I wonder if the young low-risk women preparing to give birth are aware of the public health goals. Do women who plan to have a cesarean have an interest in preparation beyond the pre-op planning they do with their care team.
Question Three: Will women think childbirth education courses are worth the time and money?
Ten years ago, researchers used data from the Listening to Women survey to examine associations between childbirth education and knowledge about childbirth interventions.3 The results were disappointing, women who attended childbirth education were no more likely to have knowledge of the risks of interventions than women who did not take classes. Contrast this to a study published shortly after that found women who attended childbirth education classes believed they were given useful information about the risks of these interventions.4
This is concerning to me, especially since most research I read about childbirth education is observational (meaning they ask women what they did). So if there is a correlation between women who attend childbirth education being more likely to have a natural childbirth, I have to wonder if that is due to the education or due to the fact that older, more educated women (who are more likely to choose to attend childbirth education) are more likely to have the birth they want.2
Childbirth education does appear to be able to reduce fear of childbirth.5 While one study found childbirth education associated with increased odds of vaginal delivery, this may be due to the high proportion of women with a planned repeat cesarean in the control group.6
What do you think? Are women of the next generation going to want childbirth education? What will they do to prepare for birth?