I got a call from an OB earlier this week. He said that he received fliers for my birth class, he would like to send couples to me, he believes couples need to be prepared before delivery, but my class is just too long, would I shorten it?
I hated to give a negative answer to an OB whose sentiments, that couples need birth education, I so passionately agree with.... but I responded with, "I really cannot shorten this class. What I offer is very specific, I fully prepare couples for a healthy pregnancy, birth, and breastfeeding relationship... I don't think I can remove any information and still provide the same quality education that couples need." And because I want to be transparent in that I do help couples achieve a natural birth... I closed my eyes... as if something could possible fall on me... and said, "Over eighty percent of my couples have an unmedicated birth. My class, all ten meetings, is necessary to help them achieve that goal if that is their goal." I will not under serve some couples to reach couples who are not willing to invest in their birth. I hoped that I didn't totally alienate this doctor by basically saying "yeah it's a long class, it's staying that way... and we won't be needing your drugs now... sooo bye thanks!" but I guess I don't care enough about possibly offending people to not teach the class I teach.
I teach the longest class in my county... it's twice as long as any other series I know of. Ten classes, 25 hours of in class instruction in addition to work outside of class. The basic premise that I take with childbirth education is that this is a surrogate for decades of birth education that every girl should be receiving from as soon as she figures out she has a vagina, and wonders what it's for. However, when birth moved out of the home, suddenly it had nothing to do with our bedrooms and our bodies and became a procedure that a doctor did to a woman, hence the constant focus on "the delivery." The doctor delivers the baby, the women does not birth the baby. Hospital classes, or very short birth classes, can only really cover this perspective of birth, what will likely happen to the women. They are inadequate to truly educate, really... re-educate, a couple in what birth is, and how to take it back, make it their own... let it be what it was designed to be. I can't just teach couples what will happen to them, I need to help couples understand that this is their birth, and empower them with the tools and information they need to birth their baby, not merely "be delivered."
In lieu of decades of information lost, I consider ten weeks to be a small compromise when we consider the amount of time we prepare of other life events.
Would you plan a wedding in three, two hour sessions?
Would you dedicate only six hours on a Saturday to the decision of buying a house?
We devalue birth, therefore we devalue birth education.
Honestly, sometimes it makes me feel insecure to stand my ground and call out a wavering community. Maybe I'm not being competitive, I'm not accessible enough to all couples, that any other educator can easily get a client by saying "I do what she does in half the time." We all have thoughts like this right? I DO think about these things... I've searched myself thoroughly on these topics... you are getting in on a late night internal dialogue, instead of laying awake... I'm writing it here... what could go wrong right?
Could I teach what I teach in fewer classes?
If I could teach what I teach in eight classes... I would. In six classes? Seriously... yes... yes I would. I love spending ten weeks with my couples, but I have no interest in wasting their time or mine. I've gone over each class, and asked what I could remove. Class seven is easy right? We just cover the pushing (though I prefer "birthing") stage. Others cover that as apart of just a fraction of a couple hour class... but somehow... my class on that single topic (which seriously encompasses so much) still ends up being a little over two hours every time. No nap time, we don't sing songs, there's no art hour... There is just a lot to know about the birthing your baby out of your vagina... an incredible, seemingly impossible feat! And when given the space, couples ask many questions about it... we could easily take that class to three hours! What about the nutrition class? That's not exactly about birth. Cut it out! However, when moms are able to keep their pregnancy low risk through nutrition, that certainly affects their birth! I could go on like this about each class.
There is nothing I could take out, everything is important. So by removing important information from class in order to condense it, I'm putting my couples at risk of being under prepared. I can't do it.
Other classes teach birth in fewer classes, those couples are fine.
Sure I guess... but I'm not going for fine. Birthing women deserve better than fine! I don't know anything about scuba diving, but I know to do it safely you have to take a class. I did a quick google and it looks like it's usually a few classes. Lets say to learn to safely scuba dive you need five classes. A scuba instructor sees that a lot of vacationers want to just take a one day class, so he offers it. Will all those people drown? Probably not. Will their experience be better than if they took no class, probably. Will some people encounter negative outcomes that they could have avoided with adequate education? I'm sure. I'm not going to teach the shorter class knowing there is more information that couples need and deserve, even if they would be more popular classes in our busy culture.
But couples WANT a shorter class!
I've heard this argument a lot, from doctors, doulas, educators... couples just aren't willing to invest more time in childbirth education, and something is better than nothing. Again with the scuba class scenario... should we offer an inferior scuba class just because people want it? This is a safety issue, even if birth is normal and natural, it's not in our culture. Inductions, cesareans, birth trauma... we are avoiding very serious complications with adequate education. I think the problem here is that because so many hospitals and independent educators are willing to teach a shorter class, often times knowing that these couples need more, people believe that a shorter class is adequate. Is it better than nothing? Yes, but we are never going to see significant change in birth in our culture if we hold the bar so low.
What I would like to see is doctors, midwives, doulas, and educators valuing childbirth education and helping couples to value it too. Continue the conversation. My experience is that when you are able to make valid arguments for why comprehensive childbirth education is important, people listen. When midwives and doulas require childbirth education, that says something! As an educator, being able to confidently share that your classes do actually make a difference (because you should be keeping track of that) is also important.
Some couples just will not take a longer class.
This is true, and they will unfortunately get what they put into their preparations for birth. That doesn't mean we should abandon the message that childbirth education is important. If we keep saying it, it will seep into our culture. If from early on, well before conception, people heard that childbirth education was essential... then that's what they would believe. You know what I heard when I was young? "Oh yeah, my Lamaze class was a joke." Let's not offer classes that don't truly prepare couples (and I'm certainly not saying modern Lamaze is a joke, before you start throwing stuff at me). If we perpetuate the cycle of birth classes that are not effective then couples will continue to see them as not necessary... because really... how big of an impact will a one day class have on a birth?
There are a lot of questions in this post that I don't have the answers to. This is a conversation. I don't think a short class is adequate based on talking to couples who have taken them... but if educators who are teaching short classes are keeping stats on them and can show that six hours of education over a few weeks does significantly decrease induction, cesarean, and complication rates and has a significant role in helping couples achieve the birth they want, then that's a conversation I want to have! This is not about attacking another class. I don't want to have the best class. I can teach six couples in three towns, every ten weeks... we need a lot of great classes in order to serve this community. I'm calling to raise the bar, because I refuse to lower mine.