As a former biology instructor I always encouraged students to observe their environments, as they are ripe with individualized roles that are filled by a species with a unique skill. The world of childbirth education is similar. While the variety of options that exists could be endless, with the right research and evidence at your back, meeting the needs of those in your community could truly set you apart and help you find your niche – and fill your classes!
Statics from the Report of the Third National U.S. Survey of Women’s Childbearing Experiences (1) show that in 2000 70% of expectant mothers were taking childbirth classes, but in 2011-2012 that figure had decreased to 59%, even though 70% of both first time and additional pregnancy mothers rate information from a childbirth education class as very valuable. We can use this information to discuss partnerships with providers and how we could be of use in popular centering models of care. From 2011-2012 mothers reported that they felt pressure from a provider to have an induction, a 7% increase from 2000. As educators we can offer evidenced-based information on when an induction is medically necessary and how to make an informed decision in the course of labor and delivery, with their provider.
Currently a hot topic at many hospitals is that mothers with private insurance take classes at a rate of 67%, while mothers on Medicaid only take classes at a rate of 52%. This disparity could be due to insurance payment willingness. With recent changes in Medicaid, reimbursement could happen more easily; knowing your local population and reaching out to local agencies that provide referral services could prove beneficial for both educators and those who had otherwise found classes cost prohibitive.
In 2000, 92% of mothers said that a partner or husband provided supportive care, while in 2011-2012 that figure fell dramatically to 77% (2)! This figure is especially compelling when the pressure from a provider to have an epidural, as reported by mothers, grew 6% from 2000 to 2011-2012 (1)! Supportive care education, including comfort measures for labor and coping techniques for non-medicated pain relief can be taught as a stand-alone course. Another study published in the Journal of Perinatal Education (3) explored the relationship of childbirth education and obstetric interventions in Canadian women and found that “attendance at childbirth education classes was associated with a significantly lower cesarean surgery rate,” nearly 20% against those who did not attend a class, supporting the findings from another study done in 1990 that “reported that rates of spontaneous vaginal birth were significantly higher among women who attended a childbirth educations class (79% vs 51%).” As hospitals and providers move to try to lower C-section rates, educators have a unique opportunity to present classes and information as a beneficial opportunity for all those involved in the birth process, from provider to mother and baby.
As a wife of a former Marine, for which the birth of our two children caused a triggering of PTSD symptoms and affected paternal bonding, the staggering lack of military/veteran focused childbirth education courses that are available is both shocking and disappointing. Current estimates of PTSD incidence in military personal from Iraq are 12-20%, with an overall estimate of 30% of military personnel experiencing PTSD (4). Many families in our courses may be veterans, or have a past abuse, or otherwise have experienced a traumatic event, and have PTSD. Post Traumatic Stress Disorder is often triggered by reliving the trauma, this can occur in a variety of ways, including shared verbal cues, smells, and lighting that are similar to the original trauma. Birth, specifically delivery, can be a trigger: medical personnel arrive, the lights go up, there is blood, and often more invasive interventions in vulnerable areas of the body (for example episiotomy and cesarean section). It is important to prime our expectant families about these procedures and interventions. It is also important for us to prompt our expectant families to think about how they will react to these procedures and to encourage them to work with their care (physical and mental) providers.
Particularly for our military and veteran clients, unless a family is currently residing on a military post or base, and only if that installation offers such a class, there are few freestanding or hospital-associated courses. Specifically, such courses that would address labor, delivery, and postpartum with a partner deployed or recently returned from deployment, traversing labor and delivery options available to patients with TriCare insurance, and accessing prenatal, pregnancy, and postpartum resources for active military and veteran families (5).
The Department of Defense (6) produced their own survey of military mothers, the results of which were published in “Birth”, showing “less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women’s willingness to recommend their specific military hospital to others were… information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making.” These studies indicated military personnel and their families are not receiving adequate childbirth education opportunities, and when such opportunities are available, the outcomes are indeed more positive. If your area is near a military installation or has a large population of veterans, contact local military resource networks to see what is and, more likely, isn’t being offered to families.
As both a CAPPA faculty member and a CAPPA Certified Childbirth Educator, I am proud to say that CAPPA Training programs and certification processes are affordable, relevant, and diverse in their approach; this diversity allows for a trainer or agency to develop their own courses and adapt to its own community’s needs. Are you finding your niche? Take a local provider to coffee or tea, sit in on a new mom’s group and listen to their needs, visit a WIC office and speak with an educator, or volunteer at your local VA family center. Know that as a CAPPA educator you are prepared and supported as you use your skill set to best serve your local population.
- R. Declercq, Carol Sakala, Maureen P. Corry, Sandra Applebaum, Ariel Herrlich, The Report of the Third National U.S. Survey of Women’s Childbearing Experiences, Eugene May 2013.
- Gruber, Cupito, and Dobson, Impact of Doulas on Healthy Birth Outcomes, Journal of Perinatal Education, 2013 Winter: 22(1): 49-58
- Stoll and Hall, Childbirth Education and Obstetric Interventions Among Low-Risk Canadian Women: Is There a Connection?, Journal of Perinatal Education, 2012 Fall; 21(4): 229–237.
- US Department of Veterans Affairs, PTSD: National Center for PTSD. http://www.ptsd.va.gov/public/family/partners-of-vets.asp
- Schachman, Lee, and Lederm. Baby boot camp: facilitating maternal role adaptation among military wives. Nursing Resources. 2004 Mar-Apr;53(2):107-15.
- Harriott, William, and Peterson. Childbearing in U.S. military hospitals: dimensions of care affecting women’s perceptions of quality and satisfaction. Birth. 2005 Mar;32(1):4-10.
CCCE, Childbirth Educator Faculty
Sarah Suhrstedt, BS, MAT, CCCE, was a community college Anatomy and Physiology lecturer and a university cadaver lab professor before leaving to become a mother. In her desire to use all evidence-based research in own personal pregnancy journey, Sarah became interested in becoming a childbirth educator. Six months after the birth of her first child she took a CAPPA Childbirth Educator training and never looked back! She started SMART Birth Services in 2014 to provide opportunities for women and families in the Portland Metro area to explore their birth options and welcomed her second child 9 months later! The adventures of having two babies in two years hasn’t stopped Sarah from continuing to build her business and learn from others as she has sought professional development opportunities and connections around the Metro area. She is eager to share her passion for education and sound birth choices to others so that they may gain confidence in their bodies and abilities, and feel prepared for the arrival of their newborn! She feels this new endeavor is her true calling in life. When she isn’t networking and business building, Sarah enjoys just being with her family and exploring all there is to offer in the Pacific Northwest!