$Unique_ID{PAR00427} $Pretitle{} $Title{Pregnancy: The Second Trimester: Planning and Preparation} $Subtitle{} $Author{ Editors of Consumer Guide Ellis, Jeffrey W Ellis, Maria} $Subject{Planning Preparation Childbirth Classes discomfort pain Lamaze Method labor psychoprophylaxis delivery relax breathing effleurage pain medication Bradley relaxation exercise exercises Dick-Read fear-tension-pain cycle breathing tension fear fears natural childbirth Kitzinger psychosexual preparations Leboyer Technique birth without violence instructor instructors self-care newborn care breast-feeding bottle-feeding labor pain breathe massage massages visualization focus home-birth refresher cesarean-section single mother lesbian lesbians language barrier parents impaired hearing vision teen teens teenage adoption VBAC sibling grandparent adoptive} $Log{} Miracle of Birth The Second Trimester: Planning and Preparation Childbirth Classes The purpose of childbirth classes is to prepare future parents to deal positively with the entire experience of pregnancy, labor, and birth. Of course, every pregnancy is unique, and no one can predict exactly what will happen and how you will feel during your pregnancy and delivery. But childbirth classes can give you and your husband an idea of what to expect when you're expecting. They can help dispel myths, ease fears, and give you the knowledge and confidence that can help make childbirth a fulfilling experience for both of you. Childbirth classes will teach you about the process of pregnancy, labor, and delivery. You will also be taught techniques to help you relax and help you deal with discomfort and pain. The more you learn about pregnancy and childbirth, the less you will fear. Childbirth classes are available in nearly every community. Some are sponsored by hospitals or institutions, while others are taught privately by certified childbirth educators. These classes are usually inexpensive or free. Childbirth preparation classes are usually attended during the third trimester. Most meet in the evening or on weekends, making it more convenient for you and your spouse to attend together. Several different methods of childbirth preparation are currently popular in the United States. Each of these takes a slightly different approach to reducing the discomfort and pain of labor and delivery. Some childbirth classes teach only one method. Others provide a broader, more individualized kind of preparation, drawing from each of several different methods. The goal of these broader classes is to enable women and their partners to discover their own style for labor. Basic to all methods of childbirth preparation is the concept that the discomfort and pain of childbirth are real, but that they can be minimized through psychological preparation. Childbirth preparation methods will not eliminate pain; rather, they teach you why pain occurs and demonstrate techniques to help you cope with it. The following are the most commonly taught methods of childbirth preparation. At the end of this section, you will find tips for choosing the class that's right for you. Lamaze Method The Lamaze method of childbirth preparation is the most popular and widely used method in the United States today. This method is named after French physician Fernand Lamaze, who believed that by concentrating on a specific distracting stimulus during labor (such as staring at a particular spot or breathing in a controlled fashion) a pregnant woman can "block" the transmission of pain impulses from the uterus to the brain. This method, also called "psychoprophylaxis," involves training or conditioning a woman to respond to her contractions by relaxing. Your "labor coach" (the individual you choose to help you through labor and delivery) is an important part of the Lamaze method. During the classes, he or she will be trained to help you consciously relax and help you use specific breathing patterns to take your mind off your contractions. The Lamaze method also involves certain physical means of decreasing painful sensations, such as light massage (called effleurage) on the surface of your abdomen and back. Since training and conditioning form the basis of the Lamaze method, it is necessary for you and your "coach" to spend time every day practicing the techniques that you learn in class. The more you practice, the more effective the method will become. Eventually, you should automatically respond to a certain stimulus with specific breathing patterns and relaxation. It should be emphasized that the Lamaze method is not the same as natural childbirth--that is, childbirth without pain medication. Not all women who use the Lamaze method will have the same type of delivery experience. Many women, for reasons of personal preference or medical necessity, will use some form of pain medication or anesthesia during their labor and delivery. Lamaze training is intended to help you cope with pain, not act as a substitute when pain medication is necessary. Accepting pain medication does not mean that you are a failure. Bradley Method Another common method of childbirth preparation is the Bradley method, named after obstetrician Robert Bradley. Unlike Lamaze, the Bradley method emphasizes true natural childbirth--that is, giving birth without using any drugs. The Bradley method stresses working in harmony with the body. It prepares the woman to experience the intensity, and pleasure of birth by using deep relaxation techniques and by tuning in to her body's sensations instead of using certain breathing patterns to distract her from her labor pains. Certain fitness exercises are also part of the Bradley method. For example, pelvic rocking exercises (see The Second Trimester, For You and Your Baby, Childbirth Exercises), are used to reduce pressure in the pelvic area and increase the flexibility of the lower back. The Bradley method is often referred to as "husband-coached childbirth," since the father plays such a major role in maintaining the mother's deep relaxation. The father is asked to observe the mother's breathing patterns as she sleeps so that he can help her to breathe in a similar relaxed fashion during labor. Childbirth educators who teach the Bradley method believe that true natural childbirth can take place if the parents are properly prepared. This method is especially well suited for couples who intend to give birth at home or in a free-standing birthing center. Dick-Read Method The Dick-Read method of childbirth preparation evolved from the teachings of Grantly Dick-Read, an English obstetrician. He identified what is called the fear-tension-pain cycle, emphasizing that fear causes tension, which leads to unnecessary pain. Because this pain causes further fear and tension, the cycle repeats itself. From this observation, Dr. Dick-Read devised a method of childbirth preparation that attempts to break the fear-tension-pain cycle. This method involves teaching the mother why pain occurs in order to help relieve her fears. It also involves breathing exercises, which are designed to help the mother release tension during labor, and certain physical exercises, which help prepare her muscles and joints for the process of labor. Today, childbirth educators who teach the Dick-Read method emphasize that the pregnant woman should work in harmony with labor; she should relax and breathe in response to her body's demands, instead of according to a set schedule. Since the Dick-Read method prepares women for unmedicated or natural childbirth, it is also well suited for those planning a home birth or those using a birthing center. Kitzinger Method Another method of childbirth preparation is the Kitzinger method, developed by English anthropologist Sheila Kitzinger. This form of childbirth preparation is not generally taught as a separate method, but rather is incorporated into the teachings of childbirth educators who primarily teach other formal methods. Frequently called "psychosexual preparation," this method teaches that childbirth is part of the wide spectrum of sexuality in a woman's life. Exercises are therefore described in terms of normal processes of the body, and emphasis is placed on working in harmony with these processes. Another major part of the Kitzinger method is the use of a variety of techniques for relaxation, including gentle massage and mental imagery to develop awareness of the body. Leboyer Technique Though not a method of childbirth preparation, the Leboyer concept of "birth without violence" is commonly discussed in childbirth classes. Dr. Leboyer, a French obstetrician, developed the concept of "gentle" delivery, which is designed to make birth less traumatic for the baby. He advocated a warm, quiet room with dim lights for the birth and a warm bath for the baby shortly after delivery. In this way, he felt that the baby could be helped into a gentle and calm transition from life in the uterus to life outside the mother's body. Choosing a Class Childbirth classes are designed to make childbirth a more fulfilling experience for you and your husband, so it pays to select the class carefully. You'll want to find a method (or a mix of methods), a class schedule, and an instructor that you feel comfortable with. Chances are, the more effort you put into finding a class that's right for you, the more you will get out of it and the better prepared you will be for childbirth. You might want to begin your search by asking for suggestions from your doctor, from friends who have taken classes, or from your hospital's maternity department. Once you have a list of possibilities, call and ask the instructors to describe their classes and their credentials. You can often learn a lot in a brief phone conversation. It may even be possible to have an interview with the instructor before registering for the class. Ask about the instructor's qualifications. Is the instructor an employee of a hospital or physicians' group? Does the instructor belong to any local or national organizations of childbirth educators? Some organizations require their instructors to have a medical background, such as nursing or physical therapy. Others require a college degree in a related field, such as psychology, social work, or education. Some have no special schooling requirements. Most instructors also receive training in childbirth education. Training may be minimal (for example, the instructor may have been required only to observe a series of classes), or it maybe quite rigorous, leading to certification by one of the national or international childbirth organizations. The certification process for these large organizations usually requires classroom sessions or workshops, written work, examinations, observations of childbirth classes, attendance at births, and teaching under supervision. Ask about the method of childbirth preparation taught in the class. Is it Lamaze, Bradley, Dick-Read, Kitzinger, or a combination of these? Ask, too, about the topics that are covered. Possible topics include self-care in pregnancy, preparation for normal and complicated childbirth, newborn care, breast-feeding and bottle-feeding, and the beginnings of parenthood. You should also find out how much time is actually spent on learning and practicing techniques for coping with labor pain, such as relaxation, breathing patterns, massage techniques, and methods of visualization and focus. Ask how many actual class sessions are involved. Some classes consist of a series of four sessions, while others consist of as many as 12 meetings. Classes generally meet once a week and may last from one to three hours each time. How large are the classes? Classes may range in size from private sessions for one or two couples to large classes for 40 to 50 couples. A small, intimate class may be important to you, or you may prefer a more diverse, larger group. If the group is large, does the instructor have one or more trained assistants who can provide more personal contact with the students? Is personal contact with the instructor by phone or by appointment available? In many communities, specialized classes are also available. Early-pregnancy classes, for example, are generally attended during the first trimester of pregnancy. These sessions cover proper nutrition and exercise, common discomforts of pregnancy and ways to cope with them, development of the baby, and changes that occur in the woman's body in response to pregnancy. Other specialized classes that may be available in your area include: home-birth classes; refresher classes, for those who had childbirth classes during a previous pregnancy; cesarean-section preparation classes, for those who know that they will have a cesarean section; classes for single mothers, lesbians, parents with a language barrier, parents with impaired hearing or vision, and teen parents: classes for mothers planning to give their babies up for adoption; classes on vaginal delivery after a previous cesarean section (VBAC); sibling preparation classes for other children in the family; grandparent classes; adoptive parent classes; and breast-feeding classes. Classes for parents after the delivery of the baby are also offered in many communities. When choosing a childbirth class, you should remember that no childbirth preparation method promises painless childbirth, nor will any method diminish all of the discomforts of pregnancy. The goal of childbirth education is to give couples knowledge and confidence that will enable them to have a positive experience of pregnancy, labor, and delivery.