Hospital-based childbirth education classes are often the choice of expecting parents who want to prepare for their upcoming birth, but those classes don’t always offer the full, “high-quality” preparation that independent childbirth education courses often do. That doesn’t mean you shouldn’t take one. Even if you plan on getting an epidural as soon as you walk through the door, you’ll need the information from the class to make informed decisions about your care.
These short, quick classes developed because patients didn’t want to spend the time or money for longer, more thorough childbirth education. Hospitals are answering consumer demand. But, while consumers are pleased that they don’t have to devote a lot of time to childbirth education, the classes don’t give expecting parents all the information they need to manage the challenges of labor and birth or to navigate the complicated maternity care system. The result is that some people feel the classes are a waste of time. The fact is, if you want to be well prepared for childbirth, you have to put the time and effort into doing the preparation, and there are no shortcuts. Hospital classes are a good component for preparation to have a baby, but they are only a piece of a complete education for birth.
It is a good idea to take a childbirth class at the hospital where you plan to give birth, and take it early (starting around 18-20 weeks). Here’s why —
- Learn about the general approach to birth in that particular hospital.
- Learn about standard procedures and expectations from nurses and doctors you haven’t met yet who may provide care during your hospital stay.
- Get another tour of the facility (or your first tour if you didn’t tour hospitals and birth centers early in your pregnancy). You’ll notice other things you didn’t see the first time around.
- Make yourself more familiar to the hospital staff, who may remember you when you are admitted in labor.
- Ask questions specific to your needs in the place and to the people who will be responsible for meeting those needs.
- Get connected to other resources you might need or get benefit from.
- Learn the basics. It’s better to have incomplete information than no information at all.
- Have time to switch hospitals and/or providers if you get a lot of red flags about the care you think you’ll receive.
Here’s what you’ll need to watch out for:
They are too short to fit in all the information that would help you be really prepared.
Bringing a new life into the world is big deal, and the healthcare system grows more complicated every day. There are a number of important topics that should be discussed, some with more depth than others, to teach you what you really need to know. That simply can’t be done in such a short time. On paper these classes may seem to cover the same material as independent classes, but in practice they just gloss the surface. You may feel that you got tons of great information because you’ll walk out with your head spinning. That’s because they’re cramming too much into a short class, not because you’re getting comprehensive education.
Follow the money.
Nurses and childbirth educators are paid by the hospital, and therefore must align their teachings with the way the labor and delivery unit works, which may or may not be evidence-based. For example, I observed a childbirth education class where a woman said her doctor told her, “Most women need an episiotomy.” This is not what the evidence shows, but it said a lot about how her doctor handles births, and indicated that she would be likely to get an episiotomy if this doctor delivered her baby. The instructor told the woman (and the class) that she should discuss the issue further with her doctor, but declined to offer other information about episiotomy and also declined to contradict the doctor’s comment. It was like watching Daniel being sent into the lion’s den. Why did this otherwise good instructor do that? In the hospital hierarchy, childbirth educators have much less power and authority than doctors. They risk losing their jobs as educators if they teach information that makes trouble for the doctors, especially the ones whose practices differ from what the students learn in class.
Epidural anesthesia is another topic that often gets glossed over with biased information because it brings in additional revenue for the hospital. Cesarean surgery hits on scheduling, number of births a doctor can manage at one time, and quality of life for doctors, so it’s a hot-button issue too. Those are big, important topics that, as a patient, you’ll need to have to non-biased information about to make informed decisions.
You may be taught more about being a compliant patient than about how to manage childbirth with informed decision-making skills.
Reread the paragraphs above. Learning how staff usually does things can help align care provider and patient expectations. This is a good thing if the expectations allow for individualized care and inspire good communication. It is not so good if they are cherry-picking the information so it leads you towards choosing their “more desired” options, or there’s an “our way or the highway” approach to patient care. A good example of this, again, is use of epidural anesthesia. Hospitals, doctors, and nurses often like it when a woman gets an epidural because it keeps her in bed where she is calm, quiet, and easy to monitor. It also keeps the anesthesiologist busy and brings in revenue for the hospital. Even though many women say they’d like to try to have an unmedicated birth, the information they learn in class and the care they receive on the labor and delivery ward pushes them towards getting an epidural. It’s not based on the woman’s medical needs or her desires for her birth; it’s based on creating compliant patients so the system works smoothly and efficiently. Part of the benefit, to the hospital and care providers, of offering childbirth education classes is that they prime attendees to become good patients who are easier to work with.
You don’t get time to practice skills or process the information.
One-day or weekend classes don’t give the opportunity to touch on information repeatedly to reinforce it, nor do they provide the time necessary for you to master skills and use them with confidence. That takes time and consistent contact with the instructor, neither of which are part of short classes.
If you take a hospital-based class as your primary form of childbirth education, make sure you supplement the information by learning relaxation techniques or comfort measures and practicing them regularly, and seek out high-quality evidence-based information from other non-biased sources. Taking an independent class and also a hospital-based class will give you a more well-rounded view of what lies ahead. Giving birth, while it is a normal process for women, is physically, mentally, and emotionally demanding. You wouldn’t take a 6 or 8-hour class on running a marathon and expect that’s all you’ll need to run the race successfully, and the same holds true for giving birth. While hospital-based classes generally aren’t enough to give you all the tools and skills you’ll need, they can still offer benefits.
Upcoming posts will explore the variety of childbirth education options available in addition to hospital-based classes.
This article is part of a series on childbirth education. Other posts in this series:
Michal Klau-Stevens is The Birth Lady. She is the creator of the Mastering Maternity™ system, a program that helps expectant parents confidently approach pregnancy, birth, breastfeeding, early parenting, and navigating the maternity healthcare system. She is a maternity consultant, pregnancy coach, consumer advocate on maternity care issues, Past President of BirthNetwork National, Lamaze Certified Childbirth Educator, and mother. Her website is TheBirthLady.INFO. Find her on Facebook at The Birth Lady page!
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