Childbirth Literacy: What We’re Up Against
If anyone is wondering whether good quality childbirth education is necessary in our “information age”, the past month offers three compelling reasons to think that women remain profoundly in need of a trustworthy, reliable resource for learning how to have safe and healthy birth experiences.
1. The December issue of Obstetrics & Gynecology reports results of a survey by UnitedHealthcare of 650 insured women who had given birth to their first child within the previous 18 months. Researchers asked the mothers, “At what gestational age do you believe the baby is considered full term?” Nearly one in four (24%) chose 34–36 weeks, half chose 37–38 weeks, and the remaining quarter chose 39–40. Researchers also asked, “What is the earliest point in the pregnancy that it is safe to deliver the baby, should there be no other medical complications requiring early delivery?” More than half (52%) of the new mothers chose 34 to 36 weeks, while fewer than 10% chose 39–40 weeks. For neither question did women’s responses vary significantly by age, ethnicity, marital status, education, region of the country, or income.
The researchers did not report which women took childbirth education classes and whether responses were more accurate among women who did. But another research team has reported that childbirth classes that include specific content focusing on risks of elective induction are effective at reducing demand for such inductions. Now that hospitals face Joint Commission core quality measures for perinatal care that include refraining from elective deliveries prior to 39 weeks, the results of UnitedHealthcare’s survey strongly suggest that educating women about the risks of cutting a healthy pregnancy short will play an important role in helping hospitals comply.
2. In the current issue of Birth, a team of midwifery researchers report findings from a qualitative study of 10 top selling childbirth advice books. The researchers used discourse analysis to gauge such factors as how the woman’s role was portrayed, whether language emphasized risk, how birth settings and providers were described, how pain and coping strategies were discussed, and whether the books provided full disclosure of best scientific evidence. While a few books provided evidence-based information, normalized the process of birth, and situated the mother at the center of decision-making, others painted birth as scary, risky, foul, and debilitating, or reinforced messages that women should cede their power to doctors and modern medicine. The researchers conclude,
The U.S. medical and obstetrical community presents itself as practicing according to best scientific evidence. However, many of the books examined, 70 percent of which were endorsed, reviewed, and/or written by physicians, did not systematically present data to support or refute common maternity practices. Why? Does evidence counter or conflict with common obstetrical practice? Will women become ‘too’ demanding or make decisions for which they are deemed unqualified?
3. RH Reality Check just posted an interview with childbirth educator, Vicki Elson, whose documentary film, Laboring Under an Illusion, explores another way people in our culture learn about birth: on television. She presents 100 clips from sit-coms, “reality” birth TV shows, movies, and childbirth education videos to juxtapose real births with fake births and “let people make up their own minds.”
Vicki describes her impetus for making the movie:
I was doing a workshop for nurse-midwives at a local hospital when a particularly ghastly and unrealistic (and Emmy-winning) episode of “E.R.” came out. The midwives said their phones were ringing off the hooks because moms were scared that they could die like the lady on TV. Meanwhile, Murphy Brown was America’s liberated TV mom who could anchor the news and stand up to Dan Quayle. But in labor, she was wilted and powerless, except when she was strangling men by their neckties. I wanted my kids and their friends to grow up with realistic, nourishing imagery about the power of their bodies to do normal things like have babies. I was working with midwives Rahima Baldwin Dancy and Catherine Stone on a workshop called “Empowering Women in the Childbearing Year,” and we started collecting clips to show childbirth educators what they were up against from the culture. It’s still a struggle to compete with compelling but unrealistic imagery that sticks in people’s minds. I expanded on that project to write my master’s thesis 10 years ago, and when the kids grew up I finally got around to updating the project and putting it on DVD so it’s more useful and accessible.”
I’ve managed to miss Vicki’s presentation at two conferences I’ve attended and have not yet seen the film, but the trailer is delightful and Amie Newman’s interview at RH Reality Check is enlightening. I suggest you click on over.