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How Helpful Are Birthing Classes?

October 07, 2011

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

If you're going to have a baby, taking a birthing class has become routine. How else are you going to get through labor? Sure, there'll be a doctor, a nurse and, hopefully, a supportive spouse or significant other nearby. But how will you learn the proper breathing techniques, the secrets to relaxing between contractions, and when (or whether) to ask for pain relief?

I never doubted the value of these classes before the births of my daughters. But are these classes as helpful as people believe?

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Questioning the Value of Birthing Classes

According to researchers in Sweden, the value of birthing classes that teach breathing and relaxation techniques is questionable. A 2009 study from the Karolinska Institute (published in the International Journal of Obstetrics and Gynaecology) enrolled more than 1,000 women in their third trimester of pregnancy and their partners. They were randomly assigned to weekly natural birthing classes or weekly "standard care" sessions. These included information about pain relief, childbirth and parenting.

When the birthing class participants were compared with women who received standard care, there was no difference between the groups when it came to the:

  • Number of requests for pain-relieving medication, including epidural anesthesia
  • Rates of vaginal or Caesarian deliveries
  • Amount of stress reported by parents
  • Satisfaction with the childbirth experience

Does this mean that birthing classes are useless or that the idea they're helpful is a myth? I wouldn't go that far. Different people may benefit from different types of prenatal care. And not all birthing classes are the same. Some breathing techniques (and teachers of breathing techniques) may be better than others. And, maybe the woman's spouse, significant other or labor coach benefits from knowing what to expect. This one study is unlikely to be the final word on the subject.

But this study does call into question the assumption I think many people have that birthing classes are invaluable and clearly helpful.

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Medication Options for Labor and Delivery

I was once told that the two conditions that cause the most pain imaginable are the passage of a kidney stone and childbirth. Having never experienced either, I can't say which is worse.

Clearly childbirth is usually very painful, although the experience is different for each woman (or so I am told). The pain comes from:

  • Pressure on the floor of the pelvis and surrounding tissue
  • Contractions of the uterus

If relaxation and breathing techniques are not working, there are very effective pain-relieving medications a woman can get during labor:

  • Meperidine (Demerol), fentanyl, butorphanol or morphine relieve pain without total loss of feeling.
  • Epidural or spinal anesthesia numbs the body from the waist down and provides regional (localized) pain relief.

While women and their doctors may prefer one of these options over another, no one option is clearly best in terms of balancing effectiveness and safety.

Regional anesthesia (such as an epidural anesthesia) tends to provide better pain relief. But it has a slightly higher incidence of side effects for the woman, such as headache or low blood pressure.

While some women opt to forego pain medications altogether and rely on breathing or relaxation techniques, it's not uncommon for them to change their minds during labor and request a pain medication.

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The Bottom Line

Labor and delivery is an exciting time for any woman and those who are close to her. Unfortunately, it can also be an intensely painful experience.

Birthing classes may be quite helpful for some, but perhaps not as routinely helpful as generally believed. Going to birthing classes may give us a sense of control. Or, maybe the techniques that classes teach give women something to focus on other than the pain.

Regardless, I don't think anyone should suggest that birthing classes be eliminated. But it's worth asking what they're really doing and whether we should be looking at other approaches to prepare for delivery.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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