Once upon a time, everyone took childbirth class. Now women turn to TV, books, and the Internet. Are they missing something?

pregnant woman

The Current State of Childbirth Classes

When did a childbirth class -- once a rite of passage -- become a burden easily dropped? Participation has dwindled slowly, say people in the industry. One survey now shows that more expectant moms learn about giving birth from television.

"Taking a course is not a requirement; you'll get to give birth no matter what," says Heidi Murkoff, author of What to Expect When You're Expecting (Workman Publishing). "It's just that they call it 'childbirth preparation' for a reason: it helps prepare you. It takes the mystery out of it. Information is empowering, and what you don't know can scare you more than it should."

So experienced experts such as Murkoff urge parents to at least consider enrolling in a class. A good one can teach you about pain relief, demystify hospital procedures, and provide a forum for questions you forgot to ask your ob-gyn. And then there's Dad: taking a class helps him feel less left out. Yet despite all this, there are also good reasons why some expectant parents may continue to avoid the adult-ed route.

Why Childbirth Education Began

Childbirth education began more than four decades ago as an attempt to change the concept of childbirth as an illness that required medical meddling. "The movement grew out of the realization that you didn't have to be zonked out on drugs during labor, and that you could have someone you love in the delivery room with you," says Henci Goer, a Lamaze International resident expert and the author of several books on childbirth. "It was about control."

Participation peaked in the '80s and '90s. But by 2005, class popularity had plummeted, according to Childbirth Connection, a nonprofit group that surveyed almost 1,600 new moms in its Listening to Mothers II survey. Class attendance fell from 70 percent of first-time mothers in 2000 to 56 percent in 2005.

Instead, for childbirth information, expectant moms are turning to television (68 percent), books (33 percent), friends and relatives (19 percent), and the Internet (16 percent), according to the survey. Even more telling: only 10 percent of women surveyed considered classes their most important source of information.

Why Childbirth Education Attendance Has Dropped

Several trends have evolved to erode childbirth education:

  • The popularity of epidurals. Three-quarters of the moms in the Childbirth Connection study had one. "Epidurals are promoted as a risk-free way of dodging the agony of childbirth, so you have people saying, 'Why do I need to learn breathing techniques?'" Goer says. Epidurals do have risks, she clarifies, and, of course, women do need to manage quite a bit of pain before they're given drugs.
  • Rising cesarean rates. This helped empty childbirth classrooms as well, Murkoff says. An amazing one in three women now ends up with a surgical delivery. "It's cutting, so to speak, into attendance," Murkoff adds. "Some women are even asking ahead for surgery. It's not surprising, then, that they're questioning why they'd need to study up on nature's birth plan."
  • Many patients simply prefer to get information closer to home. "They're listening to friends and family members," says Gail Herrine, MD, an ob-gyn at Northeast Hospital of the Temple University Health System, in Philadelphia. "Some of them are also using the Internet and magazines, and they feel that's enough." Dr. Herrine nonetheless strongly encourages her patients to attend childbirth classes.
  • Pop culture often portrays childbirth instructors as hippies indoctrinating their pupils in a philosophy of drug-free, natural childbirth. And sometimes that's not far off. When her ob suggested she take a childbirth class last year, Lucia Smith, of Hopewell, New Jersey, complied, but the educator's anti-epidural rant made Smith tune out. "I don't like pain!" Smith laments. Who can blame her?
  • Time. No one has it, and childbirth-education classes often demand whole evenings or afternoons. "Some classes we looked into stretched over weeks, requiring us to run to them after work," says Tanya Henry, of Chicago, whose son, Emmett, was born in January. "The only one we could handle was at our hospital -- a one-day, eight-hour class on a Saturday. It made for a long day, but it fit our schedule better."

How Childbirth Classes Are Changing

Childbirth educators are scrambling to change their teaching tactics. "When people are so busy, we need to find ways to accommodate them," says Chris Just, director of the Childbirth Education Program at Isis Maternity, an agency with three locations in Massachusetts. Besides a four-week course, Isis Maternity offers condensed one- and two-day sessions. Many hospitals and educators going that route have seen their class attendance rise as a result.

There are also alternatives to the group approach, including online classes and private sessions, although you'll lose the camaraderie factor, Murkoff says. Doulas -- hired labor assistants -- are yet another option. They can provide support and insight in the weeks leading up to birth, not just at the birth itself. "But you can have your doula and take classes too," Murkoff adds.

Why Childbirth Classes Are Still Relevant

What everyone wants you to avoid is the bad information that's so easily available. "Google 'epidural' and you'll get nearly 3 million hits, more than you can realistically access," Murkoff says. "And because the Internet comes to you unfiltered, there's a lot of misinformation."

For that reason, a class is definitely worth considering. Henry says the one-day class she and her husband took was well worth their time. "We liked spending a day focused on preparing, and having a labor and delivery nurse there to answer our questions," she says. "And since it was at the hospital, when the big day came, we already knew exactly where to go."

Going into childbirth blindly can be something you later regret, Dr. Herrine adds. "Labor is not a great time to start learning the ropes and making major decisions. The woman is usually pretty toasted and not thinking clearly." Dr. Herrine also points to a growing trend that gives doctors and nurses less time for bedside tutorials. More hospitals are getting rid of maternity wards as insurance rates and malpractice suits rise and Medicaid reimbursement drops, leaving a smaller number of hospitals to juggle the same number of deliveries. In Philadelphia, for example, where Dr. Herrine works, only eight hospitals have maternity wards, down from 18 hospitals a decade ago. "That means less staff to coach patients through labor," Dr. Herrine says.

As a reporter, I can understand both sides: why you'd skip class, or why you'd take one. But as a mom, I have to say I never would have gone into my first birth without some childbirth education. I ended up having a c-section -- my son was breech, and he wasn't coming out! -- but still, I felt more in control and less fearful armed with some childbirth knowledge. I'd rather have the know-how and not need it than wish, at one of the most important and intense times of my life, that I'd studied up. Just more food for thought.

Originally published in the July 2008 issue of American Baby magazine.

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