This was originally an assignment in a midwifery course. I've shared my thoughts here in hopes it helps other birth workers serve all birthing people with dignity and thoughtfulness. To read the original format of the assignment and/or references, click here.
The action step I can personally take is the first Wagner (2006) presents: educate the public about the current state of maternity care. Though I do this in informal ways through blog articles and everyday conversations with parents, I think the area in which I can be of service most is childbirth education classes. I have been a childbirth educator since 2011 yet planned most of my classes for consumers around preparing parents for the basics of birth. Timing contractions, coping with pain and discomfort, writing up birth intentions to share with hospital staff, and an overview of breastfeeding took up most of my time with expecting families. After moving through this term’s texts, online articles, and video resources, I can honestly identify that what I have been doing-and what most childbirth educators are doing-is ineffectual.
Rebecca Dekker recently broke down the current state of childbirth education in the U.S. to reveal some interesting facts useful in the discourse on public education and awareness. Firstly, only about half of all parents will ever take a childbirth education class. Out of those, only 18% take classes with independent educators who are not affiliated with hospitals. In total, only about 20% of all childbirth classes cover care options consumers have as well as risks and benefits to procedures, medications, and more (Dekker, 2018). All this combined means that most folks walking into the hospital system are lacking a well-rounded understanding of birth.
Dekker (2018) goes on to describe independent classes as more likely to create conscious consumers of healthcare services during childbirth yet notes that the primary focus of these classes is typically to help families have as natural a birth as possible. Given that hospital-based classes exist to accomplish the opposite, to help parents understand what to expect in the medical environment of the hospital, I believe there exists a problematic dichotomy in current American birth culture. Those who take classes at the hospital are better prepared to be compliant patients, but rarely understand concepts like informed consent and differences in Cesarean birth rates among different populations. Meanwhile, those who take independent classes are better prepared to understand and cope with the processes of physiological labor, but do not learn how to healthily navigate the healthcare system they walk into. This creates tension and potentially hostile environments in which to birth, which result in less positive outcomes. Additionally, natural birth classes can still churn out parents who lack understanding of key concepts like informed consent, induction birth choices, when a Cesarean birth is medically indicated, etc.
In Birth Models That Work, Ricardo Jones (2009) says “To criticize the paradigm that rules does not mean to get rid of modern medical resources that help us in truly pathological cases…the humanization of birth does not represent a romantic return to the past, nor a devaluation of technology. Rather, it offers an ecological and sustainable pathway to the future” (p. 300). This encapsulates the moderate, realistic approach that I believe childbirth classes and workshops for birth professionals need to exhibit. This is the approach I intend to reformulate my class offerings from.
Consumers need to know the basics of childbirth, learning how to cope and make decisions during the process just as much as they need to understand the concepts of informed consent and evidence-based care. Parents need to learn how to ask smart questions and then analyze information against the backdrop of their own values system. Yet, they also need to understand that they will be expected to deviate from normal if birthing in a hospital and figure out how to manage that expectation in real time. This is a tall order for people going through the intense rite of passage that is birth, but I believe people capable of making shifts to the system using their voices and consumer power. And I believe shifting the focus of childbirth education classes to be more comprehensive is essential in helping parents do this.
Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at firstname.lastname@example.org or through www.yourbirthteam.com.