Prepared Childbirth

Childbirth has often been called a life crisis. Crisis in this sense of the word is not negative, but means a time of great change and upheaval. It is time for growth and restructuring of many relationships. It is a time to assume a new role and new responsibilities. Childbirth also is a time of discomfort and a time of hard work. For a great deal of human history however, childbirth was a family or social event. Women delivered at home and loved ones were nearby, if not actually present at the birth. It wasn’t the mystery it became when laboring women began to be escorted to the hospital, left there, and brought home with a new baby a .week or more later.

The childbirth education movement began in the 1930s in Europe, Asia. and Africa and has had a variety of thrusts to it. A now-famous story was told by the English obstetrician Grandy Dick-Read, who worked in South Africa and England. He asked a woman whose birth he attended if it hurt. “No,” she responded. “Was it supposed to?” This inspired Dr. Dick-Read’s thinking that a good deal of pain in childbirth is based on fear. He developed the concept of the fear-tension-pain syndrome and published a book called Childbirth Without Fear. At that time. heavy doses of analgesia and anesthesia were commonly used in English hospitals. Dr. Dick-Read advocated providing information to women on the physiology of labor and what to expect at birth. He encouraged exercises and breathing techniques for relaxation.

Dick-Read’s book did not appear in the United States until the1940s. Its publication led to a movement for natural childbirth and the establishment of classes for pregnant women. Later, childbirth educators in. the United States added their own approaches and developed new methods of prepared childbirth.

In the early 1950s, a French obstetrician, Dr. Ferdinand Lamaze, visited Russia with a colleague to learn how the concept of conditioned reflexes was used to help women tolerate labor. This was based on the work of the Russian physiologist Ivan Pavlov and his famous salivating dogs. Dr. Lamaze taught Pavlov’s concepts in childbirth preparation classes. He focused on a series of deliberate breathing techniques, practiced until they became conditioned responses to contractions. These were meant to distract women from the pain of labor. The babies’ fathers participated in these classes and worked with their wives in exercising, relaxing, and breathing. Known as the Lamaze method, this is probably the most widely used technique for preparation for childbirth in the Western world today-although with great modifications since its introduction.

The Lamaze method was brought to the United States not by a professional, but by a mother-Marjorie Karmel-who had delivered one baby in France with Dr. Lamaze and another using his techniques. Karmel’s Thank you, Dr. Lamaze was published in the U.S. in 1959 and led to the development of ASPO, the American Society for Psychoprophylaxis in Childbirth. Psychoprophylaxis refers to the use of psychological methods (psycho) to prevent prophylaxis (pain) in childbirth.

Most Lamaze teachers today have modified the rigid breathing techniques developed by Dr. Lamaze and concentrate on more natural forms of breathing. In the early days of Lamaze classes, some women complained about feeling like “failures” if they didn’t breathe “properly” or if they required medication. Today, childbirth teachers often focus more on self-determination, on women having the knowledge to choose the way they want their childbirth to be conducted (to the extent possible given the many natural variations in labor and delivery). They provide women with a variety of tools to use for pain relief, such as relaxation, psychological support, breathing, the application of heat and cold, massage, position changes including walking, and, if necessary, various types of pain medication. Many childbirth educators teach more eclectic methods, borrowing from the Lamaze or Psychoprophylactic method and utilizing other techniques such as imagery and a relaxation program called progressive relaxation, not specific to childbearing. Some instructors use principles of hypnotherapy, massage, or acupressure.

Several other concepts have been introduced in childbirth preparation so that today it is much more than simply a way of dealing with pain. Robert Bradley, an American obstetrician, emphasized the role or the husband, developing “husband-coached childbirth,” or the Bradle:Method. Other childbirth educators stress the emotional or spiritual aspects of birth.

In the 1970s and 1980s, the emphasis of childbirth education broadened to include the immediate needs of the newborn. Another Frencb obstetrician, Frederick Leboyer, helped focus attention on the entry to the baby into the world. He encouraged reducing the stimuli that could affect the baby by turning down the lights, speaking quietly in the delivery room, and stressing gentleness in the management of the delivery Dr. Leboyer recommended that the newborn be placed in a tub of warm water, which has the unhappy effect of separating the baby from mother. While Leboyer may not have been entirely sensitive to the need of the birthing mother, his concept of gentle birth has increased our awareness of the emotional needs of the newborn. More recently, yet another French obstetrician, Michel Odent, advocated for waterbirth.allowing the mother to gently birth her newborn directly into a pool of Water. The earlier work of the U.S. pediatricians Marshall Klaus and John Kennel on maternal-infant bonding also led to change in the ways births have been conducted in the past several decades. They too are proponents of compassionate care of the newborn from the moment of birth, and for immediate support of the mother-infant relationship.

Today, generally accepted principles of childbirth education or preparation include:

That women know what is happening during the processes of pregnancy, labor, birth, and the postpartum period
That women have choices in the way they want their births conducted
That women are active participants in all aspects of birth (an early book on childbirth education written by an American obstetrician, Irwin Chabon, was called, appropriately, Awake and Aware)
That women have loved ones with them in childbirth, and that these loved ones also can participate in the birth process (the number of participants may be limited, however, by the logistics or policies of the birth setting)
That the maternal-newborn relationship be fostered by the birth and the immediate period afterward.