Earlier this month, the closing of Isis shocked
families across all of its locations in Greater Boston, Dallas and Atlanta who
had come to depend on it as a place that supported their transition into
parenthood, from childbirth education, to lactation support and mommy-and-me
circle time. But despite a steady class
business, the company needed its retail sales to stay afloat, and online
encroachment from the likes of Diapers.com and Amazon spelled its doom.
Meanwhile, on the West Coast, a chain called Day One Center that also provided birth and
breastfeeding classes recently closed, too. It seems as though few companies
have figured out the right business model for birth-related support services in
the digital age.
Even single-store independents are not immune to the
struggle, from Crunchy Granola Baby in Salem, which closed in 2011, to Mothers
and Co. in West Boylston, which shuttered in 2012 and whose owner, Jeanette Mesite Frem, now
teaches in a cozy space above a pediatrician’s office.
While every business has its own nuances, do these failures
say something about what they are selling or our willingness to buy it or
perhaps both? What about the cultural shifts: more moms working who are too
busy to devote their time to classes, or the seismic technology changes
involving everything from online communities and YouTube pregnancy videos to
apps for timing contractions?
Historically, women never needed childbirth or lactation
classes because they would have been surrounded by other experienced women
throughout pregnancy, birth and the postpartum period, providing support
through each stage. In modern times, when birth moved from the home to the
hospital, women were cut off from that network’s information, leaving a void.
The first childbirth education class in the U.S. happened in
New York City, after American Marjorie Karmel gave birth in Paris attended by
Dr. Fernand Lamaze, who was famous for his principles of painless, natural
childbirth during a time when women were routinely heavily drugged during labor
in hospitals. Karmel came home to the U.S. and teamed up with Elisabeth Bing in
1960 to offer childbirth classes in an apartment on the Upper West Side. A
decade later, about 10 percent of hospitals sponsored prenatal classes. By 1975,
most did – as they do today.
“It was a consumer movement,” Bing told me in an interview
years ago in the very space where she taught thousands of parents how to handle
contractions. “The time was ripe. It was a time when the public doubted
everything their parents had done.”
That is a very different mindset than today, where consumer
priorities seem to be less about questioning authority and more about having a
fancy stroller. In fact, only about one-third of all moms (59 percent of
first-timers) take birthing classes today, according to the Childbirth
Connection’s Listening
to Mothers III report.
To have a big impact, about 75 percent of first time mothers
should have access to maternity classes, experts say. But even at a place like
Isis, where the classes were fed by a hospital referral pipeline, they could
not charge enough to keep the doors open. The lesson is that that either parents
don’t want to pay all that much for education, or they expect their health
insurance to cover it, like every other aspect of birth; and most insurance
will only pay a fraction of it.
“Right now, the way it’s covered through insurance, it’s not
highly valued either,” says Lamaze International executive director Linda
Harmon. “It doesn’t provide full fee for service.”
In addition to concerns about cost, expectant parents are
pressed for time. With many women giving birth later in life when they may be
more firmly established in their careers, making time for classes spread out
over several weeks may be too much.
And then there’s the internet. Blogs, websites, YouTube,
twitter, Facebook groups. It seems everyone is an expert or has experience to
share, which is great but can it really replace the personal touch that teaches
women about things they may not even know they should be Googling for?
Frem says no: “It’s hard to learn online for something so
physical and emotional.” While she has started a podcast
and is considering video, she says her clients would rather meet wither in
person.
At the national policy level, there are pressures to improve
maternal and neonatal outcomes as well as lower costs by reducing cesarean
section rates and pre-term birth. Broader access to education would help achieve
all of those goals – but access to and interest in class-based education
appears to be waning.
Which begs the question: In the age of ‘massive open online
courses’ -- or MOOCs -- do we even need classes anymore?
Lamaze International, the nonprofit leader in childbirth
education that Elisabeth Bing co-founded, has been watching the cultural shift
and is now focused on “meeting women where they are,” Harmon said. That
includes their Push for Your
Baby campaign; mobilizing social media to help mothers connect, which is
the channel through which many are asking for help; a blog that contains
evidence-based information; a 40-week education email; and even webinars.
“We’re pushing out information to reach them whether they
come to class or not,” Harmon said, adding that they are also committed to
teach sound business practices to independent teachers who leading classes in
converted barns, church basements and hospital meeting space.
Robin Elise Weiss, an author and heavily credentialed
childbirth educator, lactation consultant, doula and mother of 8, agrees that
embracing change is essential but says that there are benefits from
face-to-face sessions.
“It’s hard to teach relaxation through Facebook or twitter,”
she says, though she is an avid user of both and creates a Facebook group for
each class so they can teach each other.
