What About Childbirth Classes and Birth Plans?

What should I know about childbirth classes?

There are several options for childbirth preparation classes, depending on where you live and the type of class you are looking for.

Hospital classes. Most hospitals offer a prepared childbirth class, during which you should get information about pregnancy and birth, how your body works, and the options available at that hospital. Classes vary on their coverage of coping techniques and ways to approach pain management, as well as their inclusion of holistic approaches. Some hospitals are beginning to acknowledge and include holism and complementary therapies, and this may be reflected in their childbirth classes as well. If you are considering a hospital-based class, be sure to ask about this.

Independent classes. Many independent (non-hospital) childbirth education organizations offer a holistic approach to pregnancy and childbirth preparation, and some specialize in preparing women who specifically wish to avoid medication during labor. Each of the organizations listed below offers different methods of preparing for a more holistic childbirth, although they also provide information about traditional medical options as well. Sometimes, you may have to travel to find an instructor who teaches these classes, or pay more than you would pay for hospital classes.

Below are links to the "philosophy" or "mission statement" on the website for several holistic or natural birth methods. From each of these sites, you can learn more about each method and find referrals for teachers or classes.

Birthing from Within [1]
[2]Bradley Method [3]
[4]Lamaze Method [5]

What should I look for in childbirth classes?

Look for classes that:

• Provide you and your birth partner(s) with an opportunity to practice many techniques for relaxation, coping with pain, and encouraging the movement of your baby. Because coping and relaxation techniques take some time to master and become habitual, you might find it more effective to take classes that meet weekly with time in between to practice, rather than choosing a class with a single-weekend format.
  
  
• Teach you ways to advocate for your wishes if you are birthing in a hospital or birth center.

Childbirth classes have the added benefit of giving you and your birth partner(s) the opportunity to meet with other pregnant women in a supportive environment. However, some women choose to prepare for birth without classes. Some resources are listed in Additional Readings if you choose this route.

Another way to meet women who can share their experiences with childbirth is through the La Leche League. This international organization is a peer-support group for breastfeeding, and welcomes pregnant women at their meetings. You can find a La Leche League group in your area by looking in the phone book, or by going to their website [6].

Lucia and Roberto had never taken childbirth classes and wondered if they would get any benefit, since they were already experienced parents. They heard about classes from one of Roberto's coworkers, who asserted, "I could have never made it through my wife's labor without them." Lucia asked her midwife about childbirth classes, and she encouraged Lucia and Roberto to attend. To their surprise, Lucia and Roberto found the classes helpful and learned several new ways to cope with pain, including the hands and knees position that Lucia ended up using during labor.

Ginny and Charles had a difficult time choosing a class. They found that parts of each childbirth method matched their own developing philosophy of birth. They appreciated the chance for creative self-expression in Birthing from Within classes, the focus on unmedicated birth that Bradley classes offered, the calm labor environment described by Hypnobirthing, and the recognition of women's inner wisdom from Lamaze classes. However, they settled on Birthworks classes, resonating with the Birthworks statements that women know how to give birth, and that there is no one right way to give birth.

What should I know about birth plans?

Good health and a holistic approach during pregnancy maximize your chances for an optimal birth experience and a healthy baby.

If you are still somewhat fearful-of losing control, of the unknown, of pain and how you will cope with it-it is helpful to recognize that, ultimately, there is no control to lose. Instead of worrying about "losing control," reflect on "giving in" to the birth process-and giving your body the freedom to do what it is capable of doing. Your body is beautifully designed to give birth.

This is often difficult-we are used to controlling many aspects of our lives. Dealing with uncertainty is challenging. But you can prepare by educating yourself and your partner, learning ways to cope with contractions, and talking about your preferences with your partner and your care provider. And once you know you have done all you can to prepare, it is helpful to let go and to be flexible and open to the aspects of childbirth that you cannot predict.

With this in mind, many women find it useful to prepare what is commonly known as a birth plan. This is a written record of what you would like to do during your birth. (The name "birth plan" is a bit problematic, since it seems to suggest that all aspects of birth can be fully prepared for and planned in advance. Some women and providers use the term "wish list" instead, but this phrase seems to minimize a woman's carefully thought out desires. Because it is more commonly used, we will use the term birth plan here.) The plan is a tool that you can use to communicate with your partner, midwife, or doctor during pregnancy and with the nursing staff at your hospital or birthing center during your birth.

Review your birth plan with your midwife or doctor ahead of time, so he or she can tell you whether the aspects of your plan are realistic at the place you have chosen to give birth. Your birth plan should be considered a "living" document that may change if needed. Flexibility and adaptability are helpful. Write your plan with this in mind.

A flexible plan is helpful if labor unfolds in an unanticipated manner. For example, if you give birth by cesarean section, most other aspects of your plan, such as early contact with your baby, should still be possible. Staff in some hospitals take babies born by cesarean section directly to the nursery, and parents do not see their child until the mother recovers from surgery. However, you can request immediate contact with your baby, early breastfeeding, and a calm and quiet recovery with your baby in a darkened room.

Preparing a birth plan

Start the process of preparing a birth plan by reviewing the sections: How Has Childbirth Changed in this Century, What About Pain, and What Factors Influence the Natural Progression of Childbirth. These sections give you background information about your birth choices. If you plan to take childbirth classes, you might want to wait to prepare a birth plan until you have attended a few classes.

There are several Internet sites devoted to writing a birth plan. Some let you click alternatives and print a final copy of your plan. While using these resources may seem easy, these plans do little to reflect your individuality or developing philosophy of birth.

General Considerations:

• Provide an opening paragraph, introducing yourself and your birth companions. If your partner or other persons will be helping you make decisions, explain how this is done in your family and in your culture.
• Try to briefly summarize your philosophy of birth. 
• Use positive language as much as possible. 
• Be brief. Reading takes time, and in a busy labor and delivery unit, your midwife, doctor, and nurses will appreciate a brief plan.
• Include only what is necessary and important to you. If no one gets enemas at your birthplace, don't waste space stating that you would prefer not to have one. 
• It might be helpful to organize the plan by stages of labor.
• If you have specific requests concerning your baby, include these on a separate sheet of paper. That way, if your baby must be physically separated from you for some reason you can send the baby's "birth plan" along with your baby.

Considerations about the first stage of labor:

• Discuss your plans for coping with pain, including any plans for position changes, walking, using a tub or shower, or using breathing techniques. Would you like any special equipment in the room, warm packs or ice packs, a rocking chair, or a birthing ball?
• Consider mentioning how your nurses might help you.
• Discuss your requests for fetal monitoring.
• You might include preferences for assisting labor to progress in the most normal way possible.

Considerations about the second stage of labor:

• Think about how you might like to be assisted with pushing. Some women find it useful to have someone give verbal encouragement with each push. Other women find this distracting. 
• Would you like any special equipment available in your room, such as a birthing stool or bar?
• Do you want your partner to help with the birth of the baby?
• What are your thoughts about tears or episiotomies? 
• What would you like to do with the baby immediately after the birth?

Considerations about the care of your baby:

• How are you planning to feed the baby? Do you have any special requests regarding infant feeding?
• Would you like the baby bathed for you or would you like to bathe the baby yourself?
• If your baby is a boy, what are your plans for circumcision?
• How do you feel about having the baby go to the nursery?

Additional Resources

Childbirth Preparation Books:

Active Birth: The New Approach to Giving Birth Naturally, Revised ed. 1992. Janet Balaskas. Harvard Common Press.

Birthing from Within. 1998. Pam England, CNM. Partera Press.

Ina May's Guide to Childbirth. 2003. Ina May Gaskin. Bantam.

Natural Childbirth the Bradley Way, Revised ed. 1996. Susan McCutcheon-Rosegg. Plume.

Pregnancy, Childbirth and the Newborn: The Complete Guide. 2001. Penny Simkin. Meadowbrook.

The Thinking Woman's Guide to a Better Birth. 1999. Henci Goer. Perigee Trade.

Especially for Your Partner:

The Birth Partner, 2nd Ed. 2001. Penny Simkin. Harvard Common Press.