Sunday, June 19, 2011

Increasing access to childbirth education

Earlier this week, a Los Angeles Times article condemned women for not educating themselves on childbirth options and therefore being at fault for allowing the Cesarean rate to be so high and for the interventions that happen to them when they trust their providers. 

My reaction to this article when it came out was that 1) expecting families are actively discouraged from being informed about childbirth options (by their care providers) and 2) expecting families see how pointless childbirth education is when it doesn't matter what they learn/want/say, their providers in general aren't respecting their desires and choices and in many cases actively working against the goals of the families. I also see that childbirth education is a costly expense and inconvenience in the lives of pregnant families and many women probably feel their time is better spent resting and taking care of themselves than rushing to another set of appointments.

Childbirth educators are important, don't get me wrong, but their delivery system is lacking and in many cases they are missing the collaborative relationships with care providers.

I think I had a really good idea that could address all of these issues and I'd love to talk about the feasibility of it with others.

Medical groups, doctor's offices, clinics, and insurance companies could hire childbirth educators to work in office. Their job would be to spend 10-15 minutes each appointment with families during prenatal appointments to go over options and to educate women on the process of childbirth. Rather than an additional appointment that takes 1-2 hours, short educational opportunities could be available like many clinics have dieticians and social workers.

I say get the insurers involved and require that these educators are on staff in order to make sure that providers allow them to be there. Some providers will not be difficult to convince on the virtues of this proposal but many others would. Its the ones in private practice that would be the hardest to work with.

This idea came from my midwifery training where I am basically being trained to offer short lessons in childbirth education to clients. I can see how providers themselves don't have the time to do this (and also the will) but they can contract with people who are trained and passionate about informed decision making. This is my vision for how childbirth educators can make it mainstream and break that 30% barrier.

Often that barrier is caused in part to economic factors of the families. Childbirth education is still a privilege available to those who can afford it (mainly middle-to-upper-middle-class white people). The article is flawed in saying that the blame can be put on women by ignoring the institutional and economic factors involved.

What actions would need to be taken to get this happening across the country? Who are the stakeholders who have the clout to make this happen? Grassroots advocates, childbirth educators, policymakers?

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