Do Childbirth Educators Make a Difference?
The other day, while looking through my issues of Birth for something else, I ran across a commentary* written by Lamaze teacher Betsy Adrian on why she was leaving the field after five years. She writes:
I realize now that my feelings of burn-out are much more than simply boredom with repeating myself for five years. What lies at the root of my feelings is the conflict between what I believe and what I felt I had to teach. I realized that I have had absolutely no impact on how people have babies. In fact . . . things are worse now for laboring women than when I started five years ago! Fetal monitoring is taken for granted, IVs are always started, almost everyone gets the “deluxe” high-risk treatment, whether they need it or not. . . . The cesarean rate is nothing short of alarming . . . . All of the things that I felt optimistic about early on are actually less likely to occur in a delivery experience now. I believe that childbirth is a unique experience of personal growth for a woman and her partner and that it should take place according to her needs and desires. Birth should never be “routine.” . . . [I]t became ultimately impossible for me to stand up in front of a class and expound on the virtues of fetal monitoring, IVs, being confined to bed, lithotomy position or limited nursing. I can’t do it anymore. I can’t even be “objective” and present both sides of each issue, as I have religiously done in the past. I did not arrive at my opinions irrationally. I read all the pertinent studies in fetal monitoring and IVs . . . and birthing positions. And the evidence is overwhelmingly against these routine procedures. Yet I knew that almost every one of my clients would experience all of these things anyway. I also knew that continuing to teach meant remaining in the good graces of my hospital and that if I became very vocal or militant about my opinions I would lose my source of income. . . . Sadly, I am done with childbirth education. . . . I can’t do it—not if my real purpose has to be to socialize women into accepting poor care, and that’s what we have been doing in too many cases.
Now here is the kicker: this commentary was written 30 years ago. How many childbirth educators could write the exact same commentary today? If a goal of childbirth education is to give women the information and tools they need to make decisions that best promote safe, healthy birth, clearly, we are not achieving it. The “alarming” cesarean rate Adrian cites is 35% at one hospital in her area. Thirty years later, the U.S. national average is 33%, and some hospitals have rates double that or more. Adrian attributes the failure to hospital-based childbirth education, closing with:
My ultimate hope is that childbirth education will move out of hospitals, back into the community where it belongs. Then we can devote ourselves completely to our clients, and not to the doctors and hospitals.
Is the problem simply that educators have to please their employers? I think this is an issue, but not the only one. I taught Lamaze classes independently from 1980 into the 1990s, yet, like Adrian, I quit because I could no longer stand watching my students lie down on the railroad track despite all I could do to tell them there was a train coming. And if hospital-based classes aren’t the only problem, what else is? More importantly, what more could—no, should—childbirth educators be doing about it, including hospital-based educators? What are your thoughts and ideas?
Adrian BK. Childbirth educator burn-out. Birth and the Family Journal 1981;8(2):101-103.
[Editor’s note: Excerpt from Birth contained in the post is used with permission by the publisher.]
Posted by: Henci Goer