Are antenatal classes a waste of time and cash?
Posted: Friday 12 June 2009
No
You wouldn't expect to be able to drive a car or ride a horse without lessons, so why do we expect women to give birth and them and their partners to start out as parents without good information and support? Last week researchers in Sweden reported that the antenatal teaching of breathing, relaxation and massage techniques had no effect on the use of epidurals or other birth outcomes. Since the research questioned only a small part of antenatal education, not the validity of the education itself, I am not surprised at its conclusion. It was an impossible test.
We should welcome this study as an addition to the sum total of knowledge. However, I find myself worrying that, in these cash-strapped times, it will be used as an excuse to plunge parents back into the "best they don't know what's coming" world - where a paternalistic medical profession felt that ignorance was bliss.
At the National Childbirth Trust we know that parents value learning about preparation techniques. Relaxation, movement, breathing awareness and massage are important aspects of antenatal preparation and they provide women with the skills to cope better with labour pain. Previous studies showed that those taught relaxation and breathing skills were given less narcotics during labour, received anaesthesia less often and had a higher frequency of spontaneous vaginal deliveries.
The NCT hears positive feedback from hundreds of women who found practical preparation to be of invaluable help. This is perhaps more important than any research. Our "relax and breathe" classes are proving ever more popular.
We fully accept that no matter how well you prepare a woman and her partner for birth the experience that she has depends heavily on the services that are provided by the health service. We know that when women are given positive, one-to-one emotional support and encouragement during labour there is a lower use of pain medication, forceps and Caesarean section.
We also know that better birth environments are important, which is why we want to see all women in maternity units have access to a shower, large bath or birth pool to help ease labour pain.
At the NCT we also seek to change the way that the health service operates so that the life-changing experience of birth, and the need to get it right, are respected. That means great antenatal preparation and a health service that provides what we know will work during the birth.
Perhaps we should also offer to teach the Swedes how to relax and breathe properly!
Belinda Phipps
Yes
The teacher was adamant: "You must embrace your contractions, treat them as friends, cherish them. These are the final moments before your baby is born. Your body is doing something miraculous. Just breathe in and relax."
Eight pregnant women, including me, and their husbands, including mine, nodded enthusiastically. But that was before the birth of my first child: in those days I listened attentively to everything I was told in my antenatal classes and vowed that it would all be natural. I didn't need pain relief or epidurals. I was going to love this baby out of my womb. Then I went into labour. The pain was crippling. I paced the house, gripping the furniture. My first baby was born 32 hours after I arrived in hospital, but only after the obstetrician had said: "This woman needs an epidural." After that, I felt wonderfully calm. The baby arrived and I could still manage a smile.
My teacher was horrified: "You didn't focus on your contractions - but I suppose you had a natural birth." Four other mothers had Caesarean sections, and felt horribly guilty. Worse, my antenatal course had focused so obsessively on contractions that it failed to prepare me for the first year. I barely knew how to put on a nappy. For my other three babies, I'd learnt my lesson: I didn't need lessons. All I needed was to listen to the midwives and obstetricians who deliver several babies a day. I breathed when they told me to breathe and pushed when they told me to push. Two of the babies arrived too fast for any pain relief, so I can tell you that epidurals are a deeply civilised invention.
Antenatal classes are a wonderful way to make friends with other mothers. They remind your partner that you won't be wearing skinny jeans for a while, and they do an admirable job in encouraging breastfeeding. But they should concentrate on the first 18 years rather than the first 18 hours. That would be far more useful.
Alice Thomson
