Tuesday, 11 July 2017

Childbirth Classes and Birth Plans Increase Chances for Vaginal Birth

Photo by Andy Ellison

Fewer women are taking childbirth classes in some communities. They feel they are too busy to accommodate a multi-week class or they feel that they should defer to the expertise of their care provider. They spend far more time decorating the nursery than they do planning for the actual birth.

But here is one good reason to consider taking childbirth ed classes or making a birth plan. They may lower your chances of a cesarean.

In this study, only about a third of women birthing at this particular hospital attended a childbirth education class; 12.0 percent had a birth plan, and 8.8 percent had both. This shows how underutilized these tools are in many communities.

However, those who had a birth plan had nearly TWICE the chance of having a vaginal birth as those who did not. Those who did attend childbirth ed classes had a 1.26 better chance of a vaginal birth, and those who had both childbirth ed classes and a birth plan had 1.69 the chances of a vaginal birth.

Taking childbirth ed classes and having a birth plan will not guarantee you a vaginal birth, but it is another tool in the toolkit when preparing for labor and birth.

Discussion

Of course, some L&D nurses will swear that women who come in with a birth plan have higher cesarean rates, not lower as in this study. This can be true in some situations, like those hospitals and caregivers who find it threatening when birthing women claim their independence to make their own healthcare decisions. Some will find ways to punish women who don't just automatically follow what they are told to do. A few will schedule these women for extra interventions to "teach them a lesson."

However, other hospitals truly respect women's birthing choices and will accommodate them as much as possible. One helpful thing to do is to request an L&D nurse that supports and is enthusiastic about natural childbirth but who will support your choices without judgment. Don't be afraid to request a different nurse if the one you are assigned doesn't meet your needs. Another helpful thing to do is to hire a doula, a professional labor support person, if your budget allows. Research is very clear that having a doula lowers the chance of a cesarean significantly. And of course, a provider that believes in the physiological model of birth (also called the midwifery model of care, though doctors can practice it too) is key.

Really, attending a birth is both an art and a science. The same mother with the same presenting conditions can be managed very differently by different providers. That's why it's so important to research your hospital choices and choose your caregivers wisely in pregnancy. Learning about the different choices available during birth (and the pros and cons of each) is a big part of this process. A good childbirth education class is perfect for this process, and a good birth plan helps you decide what is most important to you.

Of course, it's always important to remain flexible in your plans because unexpected things can occur. Sometimes a cesarean or other intervention is the best choice under the circumstances. Birth plans should be short and flexible, and of course the parents should take into account the advice and expertise of their birth attendants. But a road map describing where you want to go and how you'd ideally like to get there (with information about alternatives in case of detours) can be very helpful when planning your childbirth trip.

Personally, I found childbirth ed classes invaluable. I took the regular hospital classes with my first and while they were somewhat helpful, they were more a lesson in how to be a compliant patient. In later pregnancies I took various other classes, including Birth Works, Bradley, Birthing From Within, and Hypnobirthing. I found these classes much more useful so I generally recommend independent childbirth classes. Some hospital classes can be wonderful but often their content is tightly controlled by the OB staff and may not present a full spectrum of choices.

My personal favorite was Birth Works classes, which is why I became an instructor in it, but I also enjoyed Birthing From Within. I know parents who swear by some of the other classes. It's mostly a matter of finding the approach that resonates with you.

But do try to find a good independent childbirth class and get the instructor's help in making a good birth plan. It's no guarantee of a vaginal birth, but it helps.


Reference

Birth. 2017 Mar;44(1):29-34. doi: 10.1111/birt.12263. Epub 2016 Nov 15. Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery. Afshar Y, Wang ET, Mei J, Esakoff TF, Pisarska MD, Gregory KD. PMID: 27859592 DOI: 10.1111/birt.12263
BACKGROUND: To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan. METHODS: This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed. RESULTS: In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had scheduled a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls. CONCLUSION: Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.


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