The Truth About Antenatal Classes

Re-posted from The F-Word where I am currently guest-blogging.

A report out from Sweden says that attending classes teaching breathing techniques and relaxation methods has exactly no effect on your likelihood of needing an epidural. And no impact on your likelihood of needing a C-Section. And no impact on your overall satisfaction with the birth.

Now that's not to say that there aren't some worthwhile things to be taught to expecting parents. To get the low-down I spoke to my sister (Lynda) who had a baby almost a year ago and attended both NHS and NCT (National Childbirth Trust) classes before the birth. She said neither even mentioned breathing techniques or relaxation as discussed in the Swedish report. But she did have some good points about several aspects of them. Here is what she had to say:

1) NHS classes: free but a total waste of time. Around 40 individuals and couples in a theatre-style auditorium. During question and answer sessions she couldn't really hear what other participants were saying and they ran out of handouts. Pain relief methods were discussed briefly as more or less a list of options.

2) NCT classes: £140 for 2 days and one evening, much more useful. Eight individuals and couples with practical opportunities to try things, etc. The most useful thing was the focus on the emotions around birth and new babies, for instance talking about how the mother's partner might feel coming home to find the house a mess and the mother exhausted and desperate to hand the baby over. Provided lots of useful advice for the birth itself - such as bringing along glucose sweets for energy and a kneeling cushion if you wanted to try a kneeling position. Probably much of this is available in books on maternity but also in this class friends were made and a support network accumulated.

As far as pain relief was concerned she was expecting there to be real pressure on women to reject pain relief. In the event there was a run-through of different options with participants asked to make a list of the pros and cons of each type. This might sound even-handed but in fact the "cons" is a long list of unlikely medical complications while the "pros" is one single item "reduces pain" which applies in most cases. Drawing the list like this gives the impression that one pro equals one con when in reality cons like "baby may be sleepy for first hour after birth" may well be pretty trivial against the pain thing.

Worryingly they were told that using the pain-reliever pethidine gives your child a greater risk of becoming a drug addict later in life. Both Lynda and I doubt this statement - though there may be a correlation between hospitals in underprivileged areas who dish out pethidine when they don't really have enough midwives around to cope with all the women in labour and the hospitals where kids turn up eighteen years later with a drug problem. In any case the information is nothing more than a scare tactic unless it says how much the risk increases and where the data is from.

3) Pain. No class can prepare you for the pain. To quote Lynda directly "The only way they could explain to you in a class what the pain is like is if they made you stand barefoot on upturned drawing pins while they loaded you with heavy sandbag after heavy sandbag to weight you down and the only way to make it stop was to shout 'EPIDURAL'!". ...and I am supposed to be the comedienne in the family!

4) Reality. The one thing no class really told despite asking repeatedly at the NHS one was what the most likely outcome was - what percentage of women manage without pain relief, etc and what percentage of pain relief interventions lead to problems, and what type of problems. In the end of five women Lynda is still in touch with, including herself, there were two without epidural and three with epidural. In all three of the latter cases there were complications associated with the epidural (one didn't work - the pain continued, one the needle kept coming out and having to be refitted and one woman was left on crutches for several months with a small baby to look after!). Of course without access to the relevant data we just can't know how much of that is to be expected from an epidural and how much is down to bad luck or overworked staff, etc.

5) Birth plans. Apparently the NCT went on and on about how important it was for women to write a "birth plan" to take with them to hospital. Now it's understandable that women would want to have a document in hand to tell nurses what they want in different scenarios, to avoid having procedures they didn't want forced upon them when they are in too much pain to discuss things. However of those in the group who made a "birth plan" (Lynda refused despite repeated demands by class instructors) 100% ended up not sticking to it and then feeling they had somehow "failed" to have the birth they wanted. In any case who would write a birth plan that says "experience extreme pain, demand an epidural, discover it's too late, baby's heart rate slows, rushed in for emergency cesarean". Everyone writes "no pain relief, baby slips out in 2 minutes, I look stunning", and then nobody lives up to it. So sure take in some notes about particular things you're worried about seems to be good advice, but stay open minded about what happens - don't make too many plans!

6) What they don't mention. There were a few things that didn't seem to get mentioned. Particularly some of the graphic details. Like for instance "you will definitely sh!t yourself at some point". Not to freak women out but so that when it happens they know not to be surprised or embarrassed. Maybe just reading out a few accounts from women who have had babies recently would help.

So in conclusion, there seem to be some real positives from a supportive class covering what to expect throughout maternity, birth and the first year or so of a child's life, although clearly such classes should be available freely (although the NCT does offer discounted classes if mothers have financial difficulties). Information on pain relief doesn't seem to be getting through so well. What is needed in this area is accurate information about all the options and how likely the various outcomes are both nationally and by hospital and clinic so that women can make a considered choice. What is not needed is a load of piffle about trying to relax while you're in excruciating pain.

Footnote: The moment I put this up someone messaged me on Facebook to say they read it. This friend of mine said she had a planned cesarean because of problems identified earlier in the pregnancy. When they told her this she felt ... relieved. What a shame that a woman can't just decide she wants a planned cesarean and discuss that with her antenatal teacher. What's so bad about not wanting to go through a lot of pain? Give women all the information and let them choose what they want for themselves.

(By the way there is a response to this post by another feminist here).