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Is Our Childbirth Education Paradigm All Wrong?

How Much do Expectant Women (and their partners) Really Know about Childbirth?
There has been much ado in the popular media as well as the blogosphere in recent days, about a trio of studies recently released, demonstrating attitudes about childbirth—from both the maternity care providers’ perspectives, and those of their patients.  Next week, our own contributor, Dr. Michael Klein—a primary author in all of these studies—will share with us some thoughts on the results of these studies.

The line item journalists seem to have cleaved to is how little expectant women know about birth as evidenced by the article title from the LA Times piece, “Pregnant women show an amazing lack of knowledge about childbirth options, study shows.”    And yet, to take a close look at the data revealed in Klein et al’s Birth Technology and Maternal Roles in Birth:  Knowledge and Attitudes of Canadian Women Approaching Childbirth for the First Time (JOCG, June 2011) the numbers are less disparaging.

To the selection, “The most important thing in having a normal birth is the woman’s own confidence in her ability to give birth,” a total of 61.7% of respondents answered “Agree.”  (74.7% of respondents cared for by a registered midwife agreed.)  To the item, “For women, Caesarean section is as safe as vaginal birth”, a little over half (54.1%) of respondents disagreed (correctly) with this statement, while 74.9 % of respondents receiving prenatal care from a registered midwife disagreed.  The overall theme of this study’s findings?  From the study’s  Discussion section:

 

In examining nulliparous women’s attitudes towards and knowledge of important elements in contemporary maternity care, we found that women attending midwives consistently reported attitudes supporting vaginal birth over Caesarean section and less frequent use of technology than those receiving care from physicians, particularly patients of obstetricians.  Moreover, as demonstrated in Figure 2 of the study, across the board women attended by midwives were less likely to answer “I Don’t Know” to one of the 21 survey questions, followed by patients of family practice providers and, lastly, women attended by OBs.

Clearly, the type and amount of information delivered by a maternity care provider, to an expectant woman, influences how much she “knows” about birth.

And the information relayed from medical school professors to medical students influences how obstetricians think and feel about birth, suggests another recently published work of Dr. Klein and colleagues.  To read an excellent commentary on Klein et al’s study about Attitudes of the New Generation of Canadian Obstetricians…read Dr. Christopher Glantz’s commentary in Birth(June, 2011).

One blogger responded to Klein et al’s work in a humbling, self-deprecating way, acknowledging her lack of awareness of her birth options, as she quickly approached the birth of her twins.  So where does the fault lie, when pregnant women approach childbirth with less than full awareness about the birthing process, and the options contained therein?  And what about the women (and their partners) who do approach labor and birth fully aware, and ready to advocate for their hopes and desires?  Is it really reasonable to accept a popular news media claim that “Pregnant women show an amazing lack of knowledge about childbirth options?”

The LA Times article reports from Klein et al’s study that, “ Fewer than 30% of the women, all first-time mothers, said they had attended prenatal childbirth classes” and yet, when looking back at the Public Health Agency of Canada’s What Mothers Say:  the Canadian Maternity Experiences Survey, 65.6% of primiparous (first time) mothers attended a prenatal class.  This is similar to the findings of the 2002, U.S.-based Listening to Mother’s (LTM) Survey in which it was found that 70% of first-time expectant mothers attended class.  (Unfortunately, in the follow-up, 2006 version of LTM, only 56% of first-time mothers attended prenatal classes.)

In a recent post by childbirth educator, Robin Elise Weiss (pregnancy.about.com) she describes the type of prenatal class as mattering as much—if not more—than whether or not a class is taken at all.  She describes some childbirth education programs as little more than “an orientation to the hospital, doctor’s office or other entity.”  She also explains that, in her curriculum, her students do learn a whole heck of a lot about birth:  about normal birth, medical interventions…you name it.

I can echo that sentiment:  that in a really good childbirth education class, women and their partners do come away with an enormous amount of knowledge.

Klein et al’s study published in JOGC brings to light an important element in the equation:  the influence of power paradigms on a woman’s knowledge and ability to self-advocate.  Again, from the Discussion section:

 

…studies about the nature of obstetrical power and control, suggest that even a woman with clearly articulated attitudes, beliefs, and values could have difficulty navigating the professionally controlled environment of birth. (Emphasis, mine)

In my own location, an interesting battle has played out over the years:  independent childbirth education programs versus the hospital-sponsored program.  When I first began teaching classes, there were seven different independent childbirth ed. teachers vying for the studious attentions of the relatively small number of women—most likely first time mothers and their partners—who would give birth in our town of 27,000 people.   At that time, the hospital did not even offer a class.  But a few years ago, the hospital began offering its own series of classes—perhaps a program for which local allopathic maternity care providers could largely control the content of information.  Within three years of the hospital starting their program, the number of independent teachers began to dwindle.  We were suddenly competing with short, cheap hospital classes that our would-be students were opting for.
The local indes cried “unfair,” in that hospital staff L&D nurses could conduct the programs on site—rent free—with their employer picking up the tab on childbirth education materials.  Teaching out in the community, our measly one or two-hundred dollar/couple price tags were justified by the rent we paid for classroom space, childbirth education videos and other teaching aids.  And yet, our “customers” were signing up with us less and less.

Is our paradigm all wrong?
In a capitalistic, supply and demand society where price point matters, is there more than one entity losing out on quality childbirth education?  Are independent educators losing out on would-be students, and are expectant parents losing out on the quality of childbirth education they deserve?  Are the numbers of poorly-informed expectant parents growing due to lack of learning opportunity, or inundation with less-than-helpful information in this techno-savvy era?  Are expectant parents overwhelmed by access to so much information (good, bad, somewhere in between) that they lack the energy to seek out a good old fashioned, well-informed childbirth preparation course? Are the folks who do appear to be well educated on childbirth options the people who still opt for the more expensive—and more in-depth—childbirth preparation experiences, along with perinatal care from providers who still invest the time in fully educating their patients?

What if we taught all childbirth educators the skill of grant writing?  What if all independent educators wrote—and received—grants to fund their programs, allowing them to offer classes for expectant parents for no charge?  Would this “free” price tag entice more soon-to-be moms and partners to sit in on full-length, in-depth classes that seem to be a thing of the past in some hospital settings?  Would studies like those mentioned in this post show higher levels of participation in prenatal classes—and increased confidence in and knowledge about childbirth options—if there weren’t a financial barrier to that education?  Would for-profit, on-line childbirth education platforms wane in popularity while in-person programs re-gained attendance?

What do you think?

Childbirth Education, New Research, Uncategorized , , , , , , , , ,

  1. June 17th, 2011 at 10:16 | #1

    While it is likely, as your article pointed out, that midwives tell their clients more about pregnancy, childbirth, and options, the flip-side may also be true: women who know more about pregnancy, childbirth, and their options may *choose* midwives to start with. [Not having read the original studies, I can't say whether this is a possibility discussed by the studies or not.] If this is true, this means that the women who least need to know their options are the ones most likely to get more well-educated, while the women least “in the know” are most likely to remain ignorant.

  2. June 17th, 2011 at 10:48 | #2

    I have to agree with Kathy. I think many of my students who have chosen midwifery care arrive better informed at class. When I ask them if they have spoken to their midwives specifically about birth, they often reply, “Not yet.” I think they might have decided on midwifery care and my independent out-of-hospital childbirth class because there will always be a small percentage of first time parents who are researchers by nature.
    I happen to live in an area with a mix of independent but certified childbirth educators, hospital classes taught by nurses and hospital classes taught by certified childbirth educators who are not nurses but still employed by the hospital. I agree, the price tag on independent classes is higher. I would love to be able to do something that would make the choice easier for women. I think money plays a role. I also think time and relationships play a role. Many people feel too busy for a longer, more in depth class.

    Lastly, I’d like to add that I think self-health advocacy is a role we need to teach people long before they are expecting a baby. With our current “more is better” healthcare system, all people of any age and stage of life need to know how to ask questions of their care providers, how to advocate for themselves, how to get the information they need from trustworthy sources – both in person and on-line. Ideally, pregnancy is not the first time women are dealing with this issue, but in reality for many young moms who are in overall good health, it might be their first encounter with “the system.” I was unaware of this until I became involved in the care of my aging father and grandmother. My whole family reaps the benefits of my experience as a doula and childbirth educator because I understand the types of questions we need to ask to understand the options in front of us.
    Thanks for a thoughtful – non-mom blaming! – post!

  3. June 17th, 2011 at 10:48 | #3

    I believe there are several issues at work when talking about childbirth education today. If we could narrow the issues to say, 5 main areas and “attack” them simultaneously and thoroughly, AND TOGETHER, I believe we could make a significant impact.

  4. June 17th, 2011 at 17:25 | #4

    I agree with Connie, in that there are many issues at work. I was struck by Klein et al.(2011) recent cross-sectional study: “Attitudes of the New Generation of Canadian Obstetricians: How do They Differ from Their Predecessors” when reading this piece as it is relevant to the concept of attitude driving practice paradigms:

    “In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth.” (Klein, et al. p. 129)

    And the majority of younger ob’s were women! (81% >40 years old)

    The attitude of the childbearing woman toward CBE is not the issue–maternity care and those professionals in it are, including childbirth educators, doulas, and birthies who run a profit-based business. I truly believe we need to unpack the social mechanisms bending our professions to the Western zeitgeist of maternity care, and motherhood.
    That may begin by understanding our unintentional, but nonetheless collusive, role in separating women from their bodies, their emotional health, their pain (yes, I said pain), and their babies. By convincing women they must have an external source of support as we define it, is in essence, patriarchal.

    If we began the conversation with girls, they would have access to their own reproductive choices—including where, how, and with what care provider. Informed consent, informed maternity care—begins at puberty in my paradigm.

    Klein, M.C., Liston, R., Fraser, W. D., Baradaran, N., Hearps, S., Tomkinson, J., Kaczorowski, J., Brant, R., & The Maternity Care Research Group. (2011). Attitudes of the new generation of Canadian obstetricinas: How do they differ from their predecessors? BIRTH 38:2, pp. 129-135.
    I was

  5. June 17th, 2011 at 20:11 | #5

    You mention grants and offering classes for free. I think this would have the opposite effect in what you are looking for. Free often translates to “of no value”. Free means, “why should I pre-register?”, “why should I show up, even if I did pre-register?” “I’m not invested in this class, so I’ve nothing to lose by not being there.”

    Free devalues the classes. Honestly, when I raised my prices, I had more people attend my classes. People think expensive is better (and $800 stroller, anyone?) They think there’s something special when they pay a ton of money, and then (even if the product is terrible) tell friends it’s great because they don’t want to look like they wasted all that money.

  6. June 17th, 2011 at 20:14 | #6

    Looking at the Latina factor:
    In the recently published Los Angeles Maternal Birth Survey (LAMB), of the 151,813 live births in Los Angeles County for 2007, 63% of women were LATINA. Of those Latina women, 74.9% received no preconception counseling, 60% not taking prenatal vitamin; 60% were unwanted/unplanned pregnancy; 43.5 % used birth control when became pregnant; 42.5% were obese; 14% had periodontal disease; 9.6 % previous preterm birth; 24% had self-reported depression. 31% of the latina women birthing in 2007 reported discrimination. (African Americans? 47.9 %reported discrimination). Disparity of care is glaring.

  7. June 17th, 2011 at 20:17 | #7

    One more interesting tidbit…the area of Los Angeles reporting the highest alcohol use DURING PREGNANCY? SPA5–the wealthiest area of Los Angeles, predominantly caucasian. Hmmmm.

  8. avatar
    Laura
    June 19th, 2011 at 00:18 | #8

    I read another blog commentary on Klein et al that said that in that study half (or more) of the pregnant moms surveyed were in the 1st and 2nd trimesters – before they typically would take a class. So the 30% is probably an underestimate.

    One interesting affect of hospital classes is that some couples decide to switch to another hospital – a CNM told me that one of her clients had done that (and at the same time switched to her) when they took another hospital’s class.

    I teach an independent childbirth class. I’ve had a student take both my class and the hospital’s. It was interesting the difference. My class was just one-on-one, and the hospital class was larger & had lots of people that were partially forced there (I forget why) so there was very little class participation.

  9. June 20th, 2011 at 07:29 | #9

    @Deena: While I agree with you that asking someone to pay SOMETHING encourages a sense of “buy in”– ie) “I ought to go to that class tonight, since I paid for it…” I definitely can’t agree with the notion that, even if someone receives a poor product, they will still brag about it to their friends. In the case of childbirth preparation, I’m not sure that lends enough credit to the women and their partners’ psyches. If, deep down inside, they felt dissatisfied with their experience, why would they then turn around and recommend that same experience to their friends/colleagues, knowing those other folks would also come away with a sense of dissatisfaction?

    Like Laura, I (and some other independent CEs in my community) have several times had couples show up at my class, after having already taken the hospital class. At the completion of the independent class, expectant parents tend to report a more in-depth experience–in comparison to the “overview” they described the hospital class to be. Further, I have heard some women describe the hospital class as frightening–an introduction of “what’s going to happen to me, if I birth at the hospital without really knowing how to advocate for myself?”

    @ Walker: While I think “external support” for the puerperal woman has been a consistent element for centuries (well before our current culture of wanting to make a buck at everything we do) and thus, not patriarchal in its very basic element, our model of trying to make considerable profits off of women in their childbearing year is disturbing at a purely humane level. Childbirth education, doula care…those roles were never “for profit” roles until the last fifty years, or so. One could argue it is our larger socio-geographic arrangement (and capitalistic society) that encourages this paradigm. Were we all back in the day in which extended family members all lived within a two-block radius of each other–helping each other rear children in a seamless fashion, satisfied with maintaining basic health, enough food on the table, and a comfortable, modest home…there would be less drive to chase down a profit for everything we do. Women inclined to teach others about birth could do so without worrying about how much money to charge to offset the cost of childcare for their own kids. Same would go for women inclined to support other women through birth (doula care).

  10. June 20th, 2011 at 08:21 | #10

    I am a hospital-based educator who, because I am a contractor and a long-time expert in pre/postnatal fitness, has license to act with a great deal of independence. First question of clients: What do you want/expect from this class? Second question: Do you exercise, what activities, how much? Birth has many aspects, but is first and foremost a physical challenge. Confidence that your body can give birth – in DTP® parlance we call this “body trust” – derives from successful body experiences. I suspect – sincerely – we are in the pickle we are in largely due to the same phenomena that produced increased rates of gestational diabetes and pregnancy-related cardiovascular disease: we don’t live in our bodies anymore; we live in our heads. Continuing to fight this battle in our heads is not going to fix it.

  11. avatar
    Nicole B
    June 20th, 2011 at 11:38 | #11

    @Ann Cowlin
    Ann – I love it! so true – so many many women don’t live in their bodies. Birth IS a physical challenge – and if you don’t have any successful physical challenge experiences, how can you trust yourself to overcome this one? Women who are athletes get it, so quickly. Others, who are not physically active, find it so much harder to understand.

  12. June 20th, 2011 at 12:01 | #12

    @ Ann and Nicole,

    I would add to this that, the physical nature of birth (and the herculean sense of accomplishment that follows) prompts some of us to live in our bodies even more fully afterward. There’s nothing like childbirth to demonstrate to a woman just how much her body can accomplish! That sense of accomplishment…empowerment, really, can then be translated into both physical and psychological motivation to accomplish other great things, to scale other seemingly insurmountable obstacles, to know that, deep down, that same source of strength which carried a woman through childbirth, still exists to carry her through anything else life can throw her way.

  13. June 20th, 2011 at 16:48 | #13

    Oh yes, most definitely. We have a lot of history (and religion) to rewrite, or recover (like Trotula’s manifesto). By the Middle Ages it was a done deal. And under all of it, I believe, is dear Eve whose love of apples resulted in the psychic tattoo that childbirth pain is our payback. Great conversation…love it. @Kimmelin Hull

  14. June 23rd, 2011 at 09:42 | #14

    Unfortunately. attendees at childbirth education classes often receive biased and inaccurate information. So attending classes may not be the easy answer to this problem.

  15. June 23rd, 2011 at 11:00 | #15

    Dr. Grant,

    “attendees at childbirth education classes often receive biased and inaccurate information”

    I am disappointed to hear you say this (unless you, yourself, teach childbirth education classes–and speak from experience). Particularly for those of us leading Lamaze-based childbirth education programs, our entire curriculum is evidence-based, utilizing resources such as the Cochrane Collaboration, recent research released in AJOG, Seminars in Perinatology, Journal of Pediatrics, and Canadian Medical Association Journal, practice guidelines from ACOG, …and more. In fact, Lamaze’s Six Healthy Birth Practices–the core of our curricula– are entirely based on best evidence. (To acquire a list of references utilized in the development of each Healthy Birth Practice, go here and follow the link to each separate Healthy Birth Practice.)

    As pointed out in my post, there certainly are childbirth education courses out there which are biased or contain inaccurate information…such as those represented in this article, which romanticize a universally medicalized version of childbirth (even for those for whom medicalization is not warranted). Also, I’m sure there are folks who utilize fear tactics–attempting to scare all women away from birthing with doctors or in hospitals. When their teaching fails to be evidence-based, then it is no better than the 100% medicalized version of classes.

  16. June 23rd, 2011 at 20:36 | #16

    @Kimmelin Hull
    I assure you, I am even more disappointed than you to say this. I practice in New York City, and over the past 29 years I have been involved in many thousands of deliveries. Although I have never attended a childbirth education class (apart from those that I have given), I can report that women who have attended one or more of the many classes in the New York City area are exposed to many myths and misconceptions, and plenty bias. I don’t need to attend the classes to know this, I know this because these women tell me what they have learned. Most of these classes are based on “Lamaze principles,” but of course the individual instructors may have taken liberties of their own. I wouldn’t know. I do know that the attendees are, in many cases, woefully misled. When I look around the internet and see what childbirth folks are saying, I’m not surprised that this misinformation is also presented in classes. Women need to be very careful about what they read or hear, and analyze everything critically (not so easy for a lay person), and to consider the source. Just out of curiosity – when you teach women about childbirth, do you cover the potential dangers of unrelieved pain (both physiologically and psychologically)? I didn’t happen to see any reference to this on the link you mentioned.

  17. June 23rd, 2011 at 21:40 | #17

    @Gilbert J Grant MD

    “Just out of curiosity – when you teach women about childbirth, do you cover the potential dangers of unrelieved pain (both physiologically and psychologically)?”

    Great question and, thankfully, there are many ways to approach this topic. The introduction to discussing untreated pain is via the fear-tension-pain cycle popularized by Grantly Dick-Read in that, any one of the elements of that cycle can lead to an uncontrollable downward spiral, if not interceded upon. But, of course, the discussion goes much further.

    The psychological aspect of a woman’s experience during, and after, her baby’s birth is one to take seriously–which I do. Drawing from Penny Simkin’s work on birth-related post traumatic stress disorder, I present information on how women and their labor support partners can recognize when a woman is, and is not, properly coping with labor/birth pain. Having utilized epidural analgesia myself, for one out of my three birth experiences, I know how helpful and applicable this technology can be when circumstances truly call for it. I am able to draw on this personal experience, as well as my clinical and didactic knowledge, to help expectant couples understand that there are times when pharmacological pain relief is warranted–as well as when it is possible (and advantageous) to birth free of this option.

    Along with discussing all other currently popular pharmacological pain relief options (CSE, IV pain meds., epidural with PCA) we talk about alternative options for coping with labor pain: relaxation methods which capitalize on the gate control theory of neurological pain messaging, hypnosis, acupressure/acupuncture, various other relaxation techniques, nitrous oxide (of course, barely used here in the US–save for a few locales)…

    What expectant couples deserve here is the full gamut of information: just as it would be inappropriate for me (or any childbirth educator) to only talk about “natural” pain relief methods, when the couples I teach live and birth in an environment that espouses more than that, it would also be wrong of me to only present epidural analgesia as the sole method for coping with labor pain. For every option, there is a scenario that warrants it. While my personal belief may be that a greater percentage of the time, epidural pain relief is not necessary/warranted, compared to when it is the better choice, it is not for me to dictate that to my students. By providing a well-rounded education, I have done my job: I have offered them the knowledge with which to make their own informed choices.

  18. June 24th, 2011 at 18:23 | #18

    Comments recently submitted to this post have been removed, due to failure to abide by this blog site’s stated Commenting Policy (http://www.scienceandsensibility.org/?page_id=1662)

  19. avatar
    Gilbert J. Grant, MD
    June 26th, 2011 at 09:49 | #19

    @Kimmelin Hull
    The so-called “fear-tension-pain cycle popularized by Grantly Dick-Read” that you mention, and teach, has no place, I would argue, in modern enlightened discourse. It has never been proven, and never will be proven. It’s simply an invention of Dr. Dick-Read. Please, if you can, provide some evidence, any evidence, that such a “fear-tension-pain” cycle exisits. If you cannot, I do understand that you will likely delete this comment as well.

  20. June 27th, 2011 at 08:44 | #20

    Dick-Read established the F-T-P theory based on his observations of many birthing women. The issue here, is not the existence (or lack thereof) of an RCT proving the existence of this theory/process. The issue is the lived-experiences of millions of women throughout the ages. Having experienced childbirth three times, myself, I can tell you anecdotally, that the Fear-Tension-Pain cycle is VERY REAL. There are times when we need to set science aside, and our manufactured dependence on Level I evidence or nothing, and listen to the lived experiences of the individuals we study/treat/interact with.

    The idea of Fear-Tension-Pain is not limited to birth. Ask any woman immediately following a routine gynecological exam: the more she tenses up, the more the exam hurts. Ask anyone with odontophobia: the less able to mentally and physically relax during a dental exam, the more miserable the experience will be.

    Ask a person who suffers frequent headaches: by tensing the levator scapuli…the jaw…furrowing the brow…anticipating the severity of the next headache…the physical sensation of that next headache will be worse.

    This is about basic human psychology, physiology and the link there between. In medicine, in childbirth education, and in life in general, we need to put aside our paternalistic, dismissive attitudes and sometimes be willing to just acknowledge that lived experiences are equally (if not more) all the evidence we need, whether or not an RCT exists to prove the point.

  21. avatar
    Gilbert J. Grant, MD
    June 27th, 2011 at 12:46 | #21

    @Kimmelin Hull
    Obviously, there is no RCT to prove the “fear-tension-pain” cycle exists. How could there be? But how can you possible subscribe to someone (in this case, Dick-Read) who states that uterine contractions don’t hurt? Dick-read also was big commenting on women in “primitive cultures.” By this he meant African women. According to him, they birth “…with little evidence of suffering, pain, or agony…” What do think of these “observations” of Dr. Dick-Read? Just trying to make some sense of all this….

  22. avatar
    tasha
    July 14th, 2011 at 04:16 | #22

    I was sixteen when my son was born and education was much more important than any piece of paper or pamphlet they could have given me. I was an “unwed” mother who needed to be educated about risks and defects, but I READ every piece of paper or book that passed in front of me. The only problem is, I was one of those few who was the willfully informed. SO, how do we convince everyone to be that way?
    There are DOZENS of things that I would change looking back, so how can WE actually change the medical standard?

  23. avatar
    tasha
    July 14th, 2011 at 04:22 | #23

    May I also address the FTP cycle by saying that with my second child, I got to 7 cm dilated with no nurse having a clue because every time I felt a contraction, I minimized it. (Saying in my mind that as bad as it hurt last time, there is no reason to complain about it now!) (but I was medicated and exhausted the first time) However, I would give birth today before breaking a bone! (Even a pinkie toe!)

  24. July 14th, 2011 at 07:49 | #24

    Tasha,

    Your questions are extremely poignant. Through proverbial sweat, blood and tears, childbirth educators around the globe work to teach women about pregnancy, birth and the options contained therein. And yet, via resources like the Listening to Mothers surveys (Childbirth Connection) and recently published studies by Dr. Michael Klein et al., we know that still so few women are attending childbirth preparation classes. This attendance is often becoming exchanged for engagement in reading printed materials (check out your local bookstore: the pregnancy and parenting shelves are bursting with new and old tomes) as well as on-line resources. In some cases, these are wonderful tools to help women inform themselves, such as what you describe as you prepared for your first birth. Unfortunately, they lack in the interpersonal interactions boasted many in-person classes.

    Still, finding one’s way to good, solid (EVIDENCE BASED!) information is key, but I believe that’s only part of the process. To really change the communal pregnancy, birth and early parenting experience, we need to start sooner and we need the change to come “from the masses.” If the millions of women who give birth each year in our country don’t start demanding evidence-based maternity care (versus tradition-based…as if often the norm) things will not significantly change. In a culture where customer choice is supposed to reign supreme…the voice of the customer is supposed to dictate the offerings of the business from which the customer consumes.

    Take the automobile industry, for example: if Company X develops and sells a car today that only gets 15mpg…very few consumers will invest in that car because of all the knowledge building that has gone on in recent years about fuel efficiency, global warming impact, etc., etc. People looking to buy a new car will take their purchasing power elsewhere, seeking out a car manufacturer that produces a product commensurate with today’s best (or better) fuel economy technology. Company X will quickly realize that their present car make & model was a poor investment which its past or potential customers aren’t buying. They will pull that car from the line and invest their time and efforts in developing a new make and model.

    Similarly, if women–the “consumers” of the maternity care system–were to demand evidence-based care with their purchasing power, rather than settling for out-of-date and often non-evidence-based practices, their care providers would have to alter their approach–or risk going out of business. But here’s the problem: there isn’t yet enough customer demand to change the paradigm.

    So what can you do? Spread the word. Encourage a change in “product” with your purchasing power. Use your voice–whether it be in letters to governmental representative asking for things like mandated maternity care statistics reporting by hospitals, doctors and midwives, or by sharing your knowledge with friends, family and colleagues.

    The other piece of this change, I believe, is in altering the way we perceive pregnancy and birth–before we ever become pregnant. Movies, television, magazines…all these popular media venues degrade the process of pregnancy and birth to generally negative experiences. They depict screaming (and disempowered) women being “saved” by anyone and everyone other than themselves. They depict childbirth as an illness from which they must be cured. If children were raised into adults with the constant messaging that, in most cases, pregnancy and birth were a normal part of the life continuum–and that optimizing health and well-being prior to becoming pregnant is an equally normal part of living, most of us would arrive at our first pregnancy and birth experiences with an entirely different paradigm on board. (With a national teen pregnancy rate that is ever-rising and an unintended pregnancy rate that still hovers around 50%…this is about investing in and maintaining healthy lifestyles–regardless of plans to become pregnant in the near or distant future). If our population–when appropriate–was frequently exposed to normal depictions of pregnancy and birth–lacking the fear, anxiety and drama presented in series like TLC’s Maternity Ward (not sure if this is even still on)…we would be a lot less likely to approach our first childbirth experience shaking in our socks.

  25. August 2nd, 2011 at 09:36 | #25

    Kimmelin,
    Thank you for writing this and it has caused me to think a lot about how the childbirth industry presents its business and I agree that a paradigm change is in order. This past weekend, at our local baby and maternity fair, I spent time with lots of young and poor pregnant mamas who I know would greatly benefit from childbirth education classes and doula services. Of course, they don’t have the resources to pay for either. As a provider, my resources are not unlimited and providing services for little/no cost is not realistic on a large scale. You mention grant funding . . . where are the grants that will provide funding to a for-profit group? The reality is that most independent providers are not best suited to be non-profits and are therefor excluded from most (if not all) extramural funding. What is the sustainable model that will let us provide these services at a lower cost to reach a larger audience? I don’t know but I am working in figuring it out. I would love to hear your thoughts on alternative delivery models.
    Thanks – Kate Hodges

  26. August 2nd, 2011 at 09:44 | #26

    Kate,
    Your point about for-profit, vs. non-profit is an important one. For now, I think that is the crux of the issue (until we can come up with more creative programming/funding options). I know when I was first starting up my childbirth education business, I considered setting up as a nonprofit…but was daunted by the prospect of the paper work, the need for a board, etc. Perhaps tapping into resources that help folks start nonprofits would decrease the barrier to this type of business set up–also making the application for grant funding a feasible option.

  27. August 2nd, 2011 at 11:40 | #27

    Kimmelin,
    It’s not the daunting task of setting up a non-profit that keeps me from pursuing that route. I have no desire to set up my business that way, nor do I feel I should have to? Are the only people that can/should be supported in their work non-profits? Why not entrepreneurs?

  1. July 8th, 2011 at 13:08 | #1