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Brunilda Nazario, MD
Are childbirth classes for everyone? Two Columbia University childbirth experts -- Mary Lake Polan, MD, PhD, MPH, an adjunct professor in the department of obstetrics and gynecology, and Jeanne M. Coulehan, CNM, MPH, clinical practice manager and midwife in the division of maternal-fetal medicine -- offer a resounding "yes." But the thing to know, they say, is that "one size doesn't fit all." Childbirth classes vary in duration, curriculum, and approach, so do your homework before class begins. Find a class and instructor that match your personal philosophy of pregnancy and delivery, especially when it comes to the use of pain medications or medical intervention.
Polan favors a comprehensive approach, which many classes offer. They cover the gamut, from pregnancy to labor and delivery and beyond. "The more you know about what's going on, the better you're able to not be frightened and to deal with the pain," Polan says. You also need to know about alternatives for pain relief or what happens if a problem suddenly develops during labor. "Everybody should go to a childbirth class, even if you know you're having a cesarean," Coulehan adds. (Yes, there are childbirth classes tailored for this kind of delivery.)
Where should you begin? You can start with your obstetrician, midwife, or hospital for suggestions. Or ask friends and family members or search online for classes in your area.
As you hunt for options, remember this: "The goal is to have a healthy baby, not to have a peak experience," says Polan. Labor and delivery may seem endless when you're in it. But it's really only a day in this lengthy parenting affair.
Lamaze was one of the pioneers in childbirth education. Today, it remains the most widely used approach in the United States.
"With Lamaze, you're taught breathing exercises to help you breathe through the pain and not tense up," Polan says. You also learn other relaxation and distraction techniques, massage and communication skills, and positioning for labor and birth. And your childbirth partner or coach learns ways to support you throughout labor.
Use of medication and medical intervention isn't considered verboten in Lamaze. Instead, you're informed about your range of options. "It's important not to feel that you're a failure if you decide you want pain medicine," says Polan.
In addition to guidance on labor and birth, Lamaze provides information about a healthy lifestyle, early postpartum care, and breastfeeding.
The Bradley approach strongly encourages the active involvement of the baby's father. "Getting pregnant is a couple's event, and I think having a baby is, too," Polan says. "So it's helpful if your husband or significant other understands what's happening and can coach you through it." There's plenty of opportunity for labor rehearsals.
Bradley emphasizes what Coulehan calls an important life skill: progressive relaxation. "I tell patients, you'll use it during the labor process, but you'll also use it in life ... to bring inner tranquility or calmness in times of stress." (Stressful parenting, perhaps?)
Like Lamaze, Bradley informs you about wellness issues and natural approaches to birth along with how to handle worst-case scenarios. But it stresses trying to avoid medications and cesareans. Even so, Polan reminds prospective parents, "If your doctor says, 'I know you wanted x, y, or z, but you can't because there's a problem here,' you need to listen to whoever is delivering that baby."
A range of other classes and offshoots can also aid your pregnancy and delivery.
HypnoBirthing is a natural childbirth approach that uses self-hypnosis and deep relaxation, Coulehan says. It encourages women to use their natural instincts to enhance the birthing process.
Birthing From Within focuses on staying aware throughout the birth, not focusing on a particular birth outcome.
The Alexander Technique can be used by anyone to promote ease of movement, flexibility, and coordination. These principles are great for improving comfort during pregnancy, easing delivery, and aiding recovery following birth.
Likewise, special pregnancy yoga classes can prepare you for labor and delivery. And if you'd rather not take a class with others, you can find instructors who teach one-on-one classes in your own home.
Doulas and midwives are two professionals you may want to add to your childbirth team. "But it's not how many people you have with you," says Columbia University childbirth expert Mary Lake Polan, MD, PhD, MPH. "It's that they have a consistent and flexible approach to delivery."
Doulas very in the training received, but they're not certified to perform medical tasks. They provide emotional and physical support, as well as information to help you make knowledgeable decisions before, during, and after delivery. "They're more commonly used when a partner is not available," says Jeanne M. Coulehan, CNM, MPH, a nurse-midwife also with Columbia University. Or a woman might enlist a doula's support when her partner is less than comfortable in the role of coach.
"I support patients who want doulas," Coulehan says. But she doesn't typically work with one, given that she provides similar advocacy services in her role as midwife.
Midwives receive two to three years of training in midwifery school and can deliver babies in most settings -- home, birthing center, or hospital. Most have also completed nursing training and passed national and state licensing exams. Midwives can request an epidural, give narcotics, and do episiotomies (a small cut in the skin between the vagina and the rectum), Coulehan says. They have obstetricians as backups in the event of an emergency.
SOURCES:Nemours: "Birthing Classes." Nemours: "Midwives."Dona International: "Standards of Practice for Birth Doulas." Mary Lake Polan, MD, PhD, MPH; professor and emeriti chair, department of obstetrics and gynecology, Stanford University School of Medicine; adjunct professor, department of obstetrics and gynecology, Columbia University School of Medicine.Jeanne M. Coulehan, CNM, MPH, midwife/clinical practice manager, division of maternal-fetal medicine, Columbia University School of Medicine.
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