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Choosing A Birth Class: Hospital-Based Vs. Independent Childbirth Education

In our society, where birth often happens behind closed doors, and the wisdom of labor is not often shared between generations, childbirth education classes have become an integral part of the journey of preparing for birth. However, many women are overwhelmed by the options available and by the differences between hospital-based and independent childbirth-education classes.

Classes vary greatly in their approach, philosophies, and the resources they offer for labor support. Many women seek out classes that focus on methods of coping with contractions naturally, while others look for classes that provide them the space to explore their own expectations and desires for birth, and still others are interested in just learning what to expect from the process as it unfolds and how to navigate through potential complications. Independent (i.e., out-of-hospital) childbirth classes can offer all that and more.

Many people think that out-of-hospital classes are only geared toward those desiring a natural birth. That may be true for certain types of classes, but many independent educators focus on far more than just how a woman copes with the discomforts of labor. While some hospital-based classes will cover both natural and medical pain-relief options, independent birth classes will not only help women explore their options but also encourage them to find their voices to assert themselves, and often empower birthing partners to be confident advocates in the decisionmaking that arises along the way.

Research shows that how women feel about their control over the decisions made during their births impacts how they reflect on their birth experiences. Many independent childbirth classes gear their content and approach toward this, providing expectant parents with the tools needed to be as in control of their birthing process as possible and how to feel empowered and confident throughout, regardless of how they choose to cope with the labor discomfort. When women come out of their births feeling like they were in control, they have an easier time integrating the experience into their postpartum reality and transitioning into the new role of mothering.

Hospital-based childbirth classes often focus on preparing women and their partners for what to expect in terms of policies and procedures in the hospital setting, and tend to focus on the most common ways of birthing in that setting. With national statistics for epidural use ranging from 60 to 80 percent, and the vast majority of women who have epidurals not knowing that they have options other than birthing on their back, it’s not surprising that many hospital-based classes focus on when the epidural is available and how labor is managed from that point forward. What hospital-based classes often fail to divulge is the multitude of positions and choices that are still available to a woman after accepting pain medication.

Classes taught outside of the hospital often discuss the role of pain medication, as well as ways to decrease the likelihood of other interventions when getting medical pain relief. But they also spend time on active involvement in labor with pain meds and working through labor using natural comfort techniques. Independent classes encourage the practice of positioning, counter-pressure, massage, the use of compresses, essential oils, relaxation and mindfulness techniques, and more—all incredibly important tools to have in the arsenal, regardless of whether one is moving through a natural labor with intent, dealing with contractions while awaiting the anesthesiologist, working through physical or emotional sensations with an epidural, or coping with a labor too fast and furious to sit still for pain relief. Learning these techniques from someone who has used and practiced them many times can be reassuring and calming for both mothers and their birthing partners as they build up their labor toolbox.

Independent childbirth classes are taught by educators that specialize in facilitating childbirth education and who are, more often than not, passionate and incredibly knowledgeable about labor and birth and all that goes along with it as it unfolds in different settings, under different circumstances, and with different priorities. These instructors are activists in their own right—they are sharing knowledge for developing confidence and they are uncovering tools to put that confidence into practice. These tools come in the form of questions regarding consent and refusal, a woman’s rights in the laboring room, and the true art of decisionmaking. They are reminding women and their birthing partners of the need to explore their own priorities alongside the consideration of the suggestions, policies, and recommendations of their providers and places of birth.

The size of your childbirth-education class does matter. A smaller class can offer plenty of time for questions, discussion, and demonstration. Many independent educators limit their class size to ensure that the class meets the needs of all who attend. Hospital-based classes tend to be larger and often more strictly follow a certain curriculum, with less time for reflection on and discussion of material. For both mothers and birthing partners, a small class size can make a big difference in terms of the comfort in asking questions, seeking information, and sorting out priorities. When partners are the primary advocate for discussion with the provider throughout labor, their ease with and confidence in their own knowledge is paramount.

The cost of a class is often a concern for expectant parents. Some hospital classes are free, while others are comparable to the cost of an independent class. Many insurance companies will at least partially reimburse the cost of a birth class, as long as it is facilitated by a certified educator. In addition, if finances are a concern, many independent educators will offer a discount, a free spot in the class, or a barter. Again, because independent educators tend to feel strongly about sharing information and helping women use their voice, they will often gladly open space to those who may not be able to afford the standard fee.

Understanding the background of the educator is also an important part of seeking out a birth class that is the best fit for you. Although certification in childbirth education is available and encouraged by those in the birth profession, it is not legally required. Certification requires educators to work within standards set by their certifying organization and maintain current certification, which includes continuing education and community involvement.

The reputation of independent educators is built almost purely by word of mouth. Hospital classes easily gain attendants due to convenience, and will often employ a rotating roster of nurses, midwives, and others to facilitate their classes, without expectant parents necessarily knowing who will be facilitating. Independent educators, unless part of a larger group or co-op, will facilitate their own classes, with the majority of their clients learning about their services through friends, family, or community members who have had a personal experience with the educator. Many expectant parents even form lasting relationships with their childbirth educators, staying in touch throughout pregnancy and reaching out to share news and seek resources and additional classes after their baby arrives.

With so many options available for childbirth preparation, it’s a challenge to decipher what options represent the priorities most important to a woman or couple preparing for a birth. Many expectant parents are unsure of their priorities or want to explore all of their options. Many just prefer to be in a non-judgmental environment welcoming to questions, comments, and reflections. An independent childbirth class provides the restorative balance of knowledge, tools, empowerment, and support that helps to ease the transition from pregnancy into labor, birth, and the postpartum period.

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