I would love to hear what others think.
Friday, March 14, 2008
Childbirth Education Classes Increase Women's Fear About Childbirth?
Can this be true? Surely not! Don't we encourage women to go to childbirth education classes to reduce their fears? So I thought that is until I attended a conference last week and was stunned by the findings of recent research that showed that women's fear levels in childbirth were actually increased in those women who attended childbirth education classes! Where have we gone wrong? As the guardians of normal birth have we forgotten what are role is? That is promote, encourage and support women to achieve their birth with unnecessary and minimal intervention. Are we emphasizing obstetric care not midwifery care in our classes? Have we gone overboard in giving women to much information to cover ourselves? I think there needs to be a major review of the information women receive in these classes, we need to give a more balanced view. Let us not forget we are midwives and as a profession in our own right we should be creating programs that are midwifery lead and focus on midwifery and not obstetrics and let the obstetricians conduct their own classes if they choose to.
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8 comments:
I completely agree Lorraine.
I remember a group of women i cared for who had all been to the same antenatal class and fear and grown amongst them all. The group had a very high intervention rate. Do we really need classes that have this effect? What information do low risk women who can expect to have a normal birth really need? Why do we accept the societal norm of hospitalisation for childbirth? Why are we so willing to share so much information about medical aspects of care such as the myriad of screening tests, and yet we do not share with women strong evidence which supports normal natural childbirth and the use of water in labour and birth.
Thank you for your comments Carolyn. I have seen women in my Birth Beyond fear program who required my counseling session following their childbirth education classes. What about empowerment? Knowledge of all things that MIGHT happen does not bring this about, but belief in your ability to give birth does. Let us get back to what we do best as midwives.
The impact of fear, and being observed upon labour are well documented, and it is difficult to find a model of care that doesn't involve the first step on that
slippery slope.
I agree - it is very difficult to encourage women to stay confident in their own abilities to birth, if we as professionals are screening for every little thing e.g. EFM and Group B Strep. This GBS forces women to have an IV bung, and IVABs, which is often the thin end of the wedge. And the baby is still screened and monitored up the wazoo afterwards. However I know a woman whose baby died of GBS at 40 hours of age, so I get that it is serious and don't object to it too much. By the way-What do homebirth midwives do about all that postnatal temperature monitoring and ABs? Can the women not birth at home? Do the parents do all the obs on the baby? What's the deal?
In the case of EFM,I am not convinced that we need to monitor EVERY woman that we do, which encourages doctors and others to hover at screens during labour - it almost sets a woman up to fail.
This is mostly predicated on the risk element. NO-one understands or accepts that life is involved with risk, risk of a child with learning difficulties, or CP, or having nothing wrong at all!!
EFM, while somewhat useful has not decreased the level of morbidity in babies born since its introduction and pervasive application, yet it has increased the level of CS performed astronomically.
I find it very difficult to maintain a connection with the woman with a doctor breathing down my neck even outside the door because of LOC on a trace when mobilising to cope with first stage.It undermines the woman and leads to labels being placed FTP/Failed induction/ fetal distress. VE after VE, the watched pot is slow to boil, and because we are SO over-run due to the high birth rate the time constraints are huge, there is pressure to crank up the synto, thereby inducing poor traces, and causing the self-fulfilling prophecy that women can't be trusted to birth without monitoring and intervention because 'what if we hadn't been there to rescue the baby?'Yet if we had left her/nature sufficiently alone....you know the story!
As a midwife, given uninterrupted mobilising in a woman with determination to be unintervened, we can usually get her through to a triumphant second stage. But finding the primiparous woman with the confidence to birth naturally, without intervention is becoming more difficult, especially when it is so systemically and culturally easy to downplay the thin end of the wedge. We are forced to say "Sorry - our policy says we have to monitor you because of x,y,z" to get them to comply...it is turning us all into cogs in the machine. The machine of FEAR!!!
Yet I am determined to provide good MIDWIFERY care to women in this high risk environment, as best I can, without acting in the role of "obstetric nurse" fulfilling all the medically determined, butt-covering policies that are not woman-centred. We should be getting out of nature's way as much as possible and call in the obstetricians if needed. They have their place, and I have immense respect for their skills.
There is always a WOMAN beneath the 'high-risk' pregnancy who needs our care.
How long will I last in this environment, before I become a hard-faced, derogatory, compliance-inducing obstetric nurse? This is the question and answer that midwives all ask themselves, and some of them go off to work in Coles!!!
This is the major struggle I face and see my colleagues battle with on a daily basis. We are less than a year out, and the machine is eating us from the toes up. And if we as midwives are undermined, how can we help the women in our care?
I want to be a good midwife, and I take my responsibilities seriously, but I am also a thinking midwife, who does not buy the 'need' for every intervention. I am trying to find a balance here.
Thanks for comments your Laura Jane. I am challenged with the same issues as you as I try to help midwifery students develop a belief in women's ability to give birth in circumstances which can make this hard to believe at times. I have noticed in my years working with students and with women that their underlying core belief surrounding childbirth is THE most important factor determining what they think about birth. From just reading your comments I know your core belief is that birth is a normal life event for most women. You will NEVER become a hard-faced derogatory compliant obstetric nurse if you choose not to. It is as simple as that, what is not so simple is staying aware enough not to get caught in the negativity around you and keep that belief in women in the foreground despite what is happening around you. As you say ALWAYS see the woman in what ever birth she is having, this has been my my life's work maintaining my awareness and putting the woman first. I work primarily in my Birth Beyond Fear business on helping women change negative beliefs about childbirth and I am 100% sure that their beliefs can be changed and thus change their birth experience.
I couldn't agree more, Laura Jane. I think that in most cases, at least in my community, childbirth classes may increase a woman's fear of the natural process. But I think something else happens: the class may also decrease her fears about interventions even if it doesn't increase her fears of the process. I have been to three separate series of classes at different locations and I felt all of them were more about educating women on hospital policy as opposed to true childbirth education. topics covered included the stages of labor, the safety of various pain relief options (mostly medical) and when you can get your epidural.
My big pet peave is the concept of informed consent. We tell wome that epidurals are safe, that pitocin is safe, that elective induction is safe. My question is "safe compared to what"? SO if a woman is told that she can have her baby whenever she wants, that she can control the circumstances and she is lead to believe it is safe to do so it is no wonder she is left traumatized froma difficult labor and the myth that labor is dangerous, painful, and a horrific expereince is perpetuated.
So yes I do thing that for some reason childbirth education classes have increased the fear surroundign childbirth.
I am 34 weeks pregnant and have completed my childbirth ed classes, based on Lamaze techniques, through the hospital where I plan to deliver. During the classes I was tense and teary-eyed, scared as can be about the process that was being described. After each class I had panic attacks and have continued to have them almost each night ever since.
I find this thread fascinating. I have always been a person who found that education about medical procedures makes the fear far worse. I saw a tape about my impacted wisdom teeth at the dental surgeon's office. At the end of the tape, I cancelled the appointment and walked out. I was 19 at the time; I am over 45 now, and I still have the same impacted wisdom teeth, but now one is infected. It will stay there until it is either a crisis or I die. I know it's dangerous; I can't deal with it, counseling or not. I just can't. I saw childbirth education videos, and had a termination rather than a child. It sickened me to my core and I have never been able to get over it. NEVER. The only way I could have had a child would have been as a csection under a general, and since the only person I know who arranged that was rich and her husband paid for it, I didn't get to have the baby. Hence, termination and no children. She has a baby, had a fabulous experience, great recovery, no labor, and no problems recovering from the csection. He wrote the check, no problem. But I am not rich, so I get to be childless. Those education sessions never help anything, they just make it worse. Witnessing birth makes it worse, too, I tried that as well. Instead, women should be allowed to choose any birth they want without somebody whining about it. I have seen the natural birth information and frankly, it's disgusting. I would just want the kid extracted and nothing is going to change my mind. Some of us are just repulsed by the process but that doesn't mean we should be forced to be childless because our birth choices don't suit somebody else's agenda.
Having babies is a big and very important decision. It should be planned well. There are many women who fear of getting pregnant. Some of the fears are scared of losing their freedom, losing their job, scared of taking responsibility, loosing figure. Some think they don't have enough money to have a child. But one can over come out of it by managing everything properly. To get some tips on how to over come the fear of getting pregnant, refer Getting Pregnant
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