Why America Is at a Crossroads With Childbirth Education

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. 

Breeches and rickets: Lessons from Episode Two of the PBS Series Call the Midwife

Episode Two of PBS’ Call the Midwife gave us two births that most contemporary pregnant women don’t have to deal with. (You can read my post on Episode One here.)

The show included a woman with rickets, which is a vitamin D deficiency that was common among poor women who did not have a proper diet. The affliction can cause bones to bend – often noticeable in bowed legs, as in below – but can cause the pelvis to be misshapen as well. Sometimes the deformity could be so bad that there was no way for a baby to be born vaginally.

The mom in Episode Two had had a fatal outcome with a previous pregnancy but was able to have as c-section this time around thanks to the National Health Service covering the costs. If there is ever a time for a c-section, that would be it.

The other interesting birth was a breech, shown coming out “ass first,” as nurse Chummy (below) deadpans during the delivery. 

The scene shows how breeches can be born safely if patience, wisdom, experience and the right birth positions are applied. Today, sadly, very few women with breech babies are allowed to give birth vaginally by their doctors – mostly due to a lack of experience in knowing how to gently guide the baby out. It’s an artful midwifery practice we are losing – and shouldn't.  I’ll leave it to the sage midwife Ina May Gaskin to explain why. 

Why becoming a doula is important now

Today, I present a guest post from Gina Forbes, the Workshop Coordinator at toLabor.

Becoming a doula is important now, more than ever.   With the current political climate and the recent attacks on women's health care and civil rights, it seems very clear that this is a precarious time in American culture.  Yet, I also feel that we are on the cusp of something bigger and better.  Every day, I learn about more individuals making greener, healthier choices for themselves and the planet.  People are beginning to rise up and live consciously.  This gives me hope.

As a birth advocate, doula, childbirth educator, and Workshop Coordinator for toLabor, I have thought long and hard about the role of a doula in this cultural and consciousness shift.  What is the greater significance of being a doula?

The answer is this: that EVERY person deserves to have autonomy over their bodies, their babies, their families, and their choices.  It is a human right, a civil right.  Every person who becomes pregnant, gives birth, and becomes a parent deserves to have high-quality, loving and compassionate care around this incredible time in their lives.  Doulas are people who are trained to respect that principle as the basis for all other work they do in their role as birth professionals.  Doulas ideally embody the role of empowered human being, facilitating a process of transformation and support for each and every client.  No matter what the birth experience looks like, doulas should be there to create the space for their clients to claim their choices, their autonomy, and their unique voice.  If done successfully, this paves the way for those individuals to become empowered, healthy, confident parents, which will have a direct impact on the quality of future generations' lives.  Birth matters!

I am an advocate for toLabor, the Organization of Labor Assistants for Birth Options and Resources, because toLabor exemplifies these beliefs in their doula training and certification program.   toLabor aims to return the focus of control to the laboring woman, to create the space and support for her to have her own voice, to be included and central in her birthing process.  toLabor understands the importance of empowering families, honoring birth, and changing lives.

Join the Community of Change.

toLabor will be having a doula training workshop in Jamaica Plain, MA on May 18-20.  For more information on that workshop, please contact local sponsor Catherine McKeown-Lindsey at catstamatos@yahoo.com or at 617-817-5397.  For other workshop listings and more information on toLabor, please visit the website at www.tolabor.com.