Childbirth Education: Supporting Choice.

Teaching women about homebirth and hospital birth in the same childbirth education class is challenging. The obstacle many educators have to overcome is their own strong stand for homebirth and midwives. But from the outset, in my opinion, the teacher's primary responsibility is to support the parents' right to choose the place of birth they feel will be the most comfortable for them. If the educator cannot truly support parents' choice to give birth with an obstetrician in a hospital, she should be teaching only homebirth classes.

However, even when an educator is clear that she earnestly supports the choice of her hospital-bound students and that she appreciates technology when it is used appropriately, some students may assume that because she advocates homebirth and midwifery she is at heart opposed to all hospitals, technology, and doctors. Many people tend to think in absolutes. They don't realize that educators can be pro-homebirth and midwifery and still support couples who make other choices.

Even if we are oriented to homebirth and midwifery, we can still give the hospital bound couples important skills, support, and encouragement. Some of these parents lack confidence in themselves and find it difficult to trust in the process of natural birth. In this case I help them gain the confidence they need in order to believe they can birth without technical assistance. As a result, the majority of my hospital birth students have had beautiful, unmedicated births. They are highly motivated and they work hard to create positive birthing experiences.

On the other hand, homebirth families sometimes come to class with very inaccurate, negative ideas about hospitals and doctors. Sometimes they even refuse to learn about complications, hospital procedures, or cesarean sections because "they are not going to need any of that." Some believe that if they learn about complications and interventions they will manifest them; so by avoiding the subject, they will keep complications at bay. To me, this kind of rigidity is a red flag and needs to be addressed. I tell the couples that the lesson of birth is surrender (merging one's power with the power of the experience), which is distinct from submission (giving up one's power). Gently, I explain how necessary it is to be flexible, and tell them about when and how interventions can help. I continue to validate the ideal of as little intervention as possible.

I find it empowering to illuminate the students' differences. For instance, when one couple plans to circumcise and the other does not, I encourage the couples to tell each other--respectfully--why they have made the choice they have. Parents who are undecided can hear both sides and make up their own minds without the teacher having to reveal her own bias.

It is important to cultivate a non-judgmental, mutually supportive, environment between the parents in a class. This impartiality acts as an emotional safety net for couples, especially for those whose births will go on to be less than their ideal. In one of my recent groups, a confident homebirth couple ended up having a thirty-five-hour labor that concluded in a hospital birth with an epidural. On the other hand, a hospital couple, who had had many self-doubts throughout the class, had an equally long labor with labor support and no drugs in the hospital. Birth :is full of surprises, and our goal as educators is to prepare families for any eventuality, no matter if they planned a homebirth or a hospital birth.

--Reprinted with permission from Cordelia Hanna; first printed in The Birthkit, Summer 1997. Cordelia S. Hanna is the owner of Full Moon Childbirth Support Services. She is a certified childbirth educator, certified birth assistant, and student midwife in Los Angeles County, California.