Sunday, November 23, 2008

Is childbirth education possible?

I used to call myself a childbirth educator. I used to teach classes for expectant parents whose minds were as thirsty for the words and concepts of childbirth as the desert sand is for rain. I used to use the doll and pelvis, and speak with authority on optimal fetal positioning. I knew that to stand in front of a room full of eager, intelligent women and their men was a rewarding, satisfying event. I had what they wanted - the knowledge of childbirth.

As time has passed I have become progressively less interested in trying to explain the secrets of birth in a didactic, classroom setting. In fact, I ask myself the question in the title of this blog, "Is childbirth education possible?" A short course in obstetrics, or even midwifery, does not educate anyone to be able to give birth.

Of course you can be educated about what happens as labour gets established; about the colour of the amniotic fluid and normal progress in labour. "We" (those in the know) can educate "them" (those anticipating childbirth), using language passed down over hundreds of years of our civilisation - many of the words being Latin. Those being educated quickly learn that the labia are the lips; the cervix is the neck; the liquor is fluid; rubra means red, and alba means white.

Some forms of childbirth education have moved away from the medical language and call the uterus the womb; contractions are surges; the ilium is the hip bone and the ischium is the sit bone.

When teaching childbirth classes in a hospital I had access to wonderfully coloured charts and educational aids. A class in the series was about the options for pain relief in labour. There was a plastic model of the spine, with each vertabral bone sticking out from the plane, and an illustration of where the long needle was placed so that an epidural or spinal anaesthetic could be injected. Another class included a tour of the labour ward. Fathers-to-be were particularly impressed with the machinery of birth: the machine that goes 'ping', the electronic fetal monitor, being able to attract a crowd of curious onlookers. Classes like this are going on in maternity hospitals every week. Education about obstetrics; orientation to the maternity facility; preparing people for what will be done when the time comes for their babies to be born: yes. But education for childbirth? Not really.

I have listened to education that focuses on emotions experienced in labour. Dads-to-be are exhorted to support and encourage their partner in practical ways. Mums-to-be are prepared for their crisis of confidence. Supporters are told that the (support) chain is only as strong as the weakest link. You must hold faith. You must believe.

When I was pregnant with my first child in 1973, I was impressed with the Lamaze childbirth education, and attended a series of classes. The French doctor Lamaze, who taught breathing techniques and psychoprophylaxis and talked about Pavlov's dogs and conditioned reflexes, had eclipsed his English colleague, Dr Grantly Dick-Read, who taught that pain in childbirth could be minimised when the labouring woman understood what was happening, and thereby approached birth without fear. Dick-Read is considered by many to be the father of the childbirth education movement. Today I encourage mothers to learn in a maieutic way, intuitively.

Today many classes are available, and I cannot make comments on individual styles of education for childbirth. My observation is that education is about head knowledge. It's about understanding the processes, rather than enabling the fulfilment. As I said, a short course in obstetrics, or even midwifery, does not educate anyone to be able to give birth.

Giving birth is not an act of a conscious mind. It is not something that we can plan or organise or control. Giving birth is the climax of an amazing process in which physical, emotional, and hormonal systems are orchestrated within the bodies of the mother and child. Giving birth requires the mother and all who are close to her to firstly learn to work in harmony with her body, then when the time comes to yield to her birthing power. That learning is done on the job. The mother must willingly engage with her labour, without any distraction, and learn intuitively what will assist and what will hinder her progress. She must choose to be strong; not expecting to share her job with anyone. Her support team or even her midwife cannot do this for her. It is internal learning, and knowing.

A young mother had been labouring through the day, and her labour became strong as the night progressed. From palpation I knew that her baby was a good size. I estimated that she should be coming up to full dilatation by about 1am, and I prepared myself for a birth at home. Baby's heart beat was consistently good.

By 3am I was wondering where the baby was. I checked internally and found that the cervix was probably fully dilated, but the head was high - well above the ischial spines. It had barely entered the birth canal.

By about 7am, after doing all we could to encourage progress, we agreed to transfer to hospital and get some help. However, the traffic in Melbourne at that time of day is heavy, so I suggested we wait a while.

By 8am a major change had occurred. The young mother had found the way! With new strength that she could not have known existed, she brought her baby through her birth canal, and on view. Each effort was amazingly effective.

How did she do it? Childbirth education classes had not taught what she needed to know that morning. She learnt from within herself, using the God-given intuitive knowledge that mothers have to enable normal childbirth. It wasn't the encouraging words of "You can do this", or any instruction from me or anyone else. A woman gave birth to her first child.

Our hearts were overflowing with thankfulness to the giver of life as we welcomed that beautiful child.

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