Expectations of Antenatal Education
As an antenatal Hypnobirthing teacher and postnatal trauma practitioner, one of the things I notice is that a lot rests on antenatal education for birth preparation. Often the first major investment and investigation into Birth / Parenthood that expectant parents make; finding and working with teachers and practitioners who are drawn to the work due to experience, passion or frequently - both.
One of the things I notice is that parents can either feel deeply empowered or disappointed by the antenatal education they received. At The Birth Trauma conference in 2017, Milli Hill stated that when birth journeys feel difficult and out of control, it’s often because of expectations from ante-natal classes not being fulfilled. This is most probably because this is their predominant place of interaction and preparation for the birth.
In order to feel either empowered or disappointed there must be an inherent expectation that is held of antenatal education by the parents and a sense of influence by the practitioners.
As an antenatal teacher who feels this sense of responsibility, I am interested in what some of those expectations might be, so approach this area of perinatal care can be approached more meaningfully.
Parents Expectations of Antenatal Education
For those expecting their first baby, an antenatal education course often represents their first major time and financial investment into birth preparation. Through information and resources, the aim is often to gain an understanding and a sense of what birth may be like for them and of course the unspoken question, will they be able to handle it?
Going to an antenatal education class can be about meeting other parents in a similar position, gaining birth information and knowledge that until that point hasn’t been present for them (unless they are a birth professional), getting an understanding of the process of birth so they know what to do and when.
In most antenatal classes parents attend, there is a strong focus on vaginal births. This makes sense as the majority of births (approx. 75%) are vaginal. However, that leaves 1 in 4 expectant parents slightly under informed about the process of their birth prior to it happening. This can lead to a sense of nervousness, fear and anxiety, or afterwards, a sense of disappointment and dissatisfaction at the quality of their preparation.
This does not just apply to caesarean births, those whose birth has felt out of control, unknown and misrepresented from their initial expectations also share those feelings, as well as anger.
That anger can then channel back to the place where parents feel those expectations were first raised, supported or encouraged – antenatal education.
Just as strong positive emotions around birth can validate the antenatal teaching they received, difficult experiences can lead to disappointment and frustration.
Antenatal Education Teacher’s Expectations
As mentioned earlier, many antenatal teachers re-train to this role after their own experiences, particularly positive and want to share this with others on the journey. I feel this is certainly the case in Hypnobirthing and it is heartening to see women (generally but not exclusively) feeling empowered, connected and excited by birth, so much so that they choose to teach about it.
I asked several antenatal teachers what their expectations of their courses and expectant parents were, these were their responses: non-judgemental, informative, open, approachable, supportive.
None stated they were looking to create divides in birth experiences or preparations, so it is worth asking the question; if that is not the intention, why is it happening?
My personal feeling is that the style and delivery of antenatal education is not in line necessarily with where birth now is societally, personally and culturally.
Most classes are taught in classroom style and the focus is on information rather than practical techniques that parents can actually use to cope.
Hypnobirthing offers a practical solution to this, which is why it is often talked about positively. However sometimes it can be associated with a style of birth and in these cases, it can be considered as creating false expectations. When taught without any bias, it can be very useful in helping expectant parents prepare for and manage birth.
Environmental Expectations of Birth
Society doesn’t talk about, look at (only recently have birth photos been allowed on Instagram & Facebook) or reference birth in day to day life. Overall the general consensus is that birth is painful, difficult and unsafe. This is how it is and it is a narrative often passed down through generations of women and in our media.TV and film are full of women in hospitals screaming during birth (OBEM?!)
If birth stories are shared they tend to be from those who have had difficult experiences and are yet to process the events. There is a collective subconscious negative bias towards birth in society and this is with many parents when they prepare for birth.
Despite this people still attend antenatal classes that are geared towards a more positive approach to birth such as NCT or Hypnobirthing. In light of this, antenatal practitioners tread a delicate line between creating positive expectations and information and coping tools that support their emotional wellbeing when birth journeys deviate from expectations.
Next steps in antenatal education as realistic and meaningful birth preparation
In a 2001 study, it was stated that ‘A significant proportion of women expressed dissatisfaction with the amount of practice of coping strategies during antenatal classes. The findings of this study of a group of well‐prepared women raise questions about the correct components of antenatal classes…’
Antenatal education needs to focus on giving practical coping tools for labour and birth as well as being empowering with information. Expectant parents who are preparing for birth need to have information but understand how they can positively apply this to their particular birth situation in a way that feels positive for them.
There is no one shoe fits all and no one has the absolute answer, as birth can unfold in so many ways and the experiences are subjective. Yet we can support through practical coping tools such as breathing, hypnosis, understanding physiology, giving support and building up the resources parents have at their disposable in a positive and realistic way.
The Positive Birth Movement has created facilitated peer support groups that are changing the way birth is discussed and approached, which is incredibly necessary. It also brings birth discussions back into informal community settings.
Another incredible leap is the work of Make Birth Better in understanding what isn’t working currently and giving meaningful resources to help improve the perinatal models that are currently available.
Antenatal education is an important piece in this process for many parents and us teachers have a responsibility in disseminating evidence, offering coping tools and talking about birth without bias.
Sakina Ballard is a Hypnobirthing Teacher, Positive Birth Movement Facilitator and Birth Trauma Resolution Practitioner, working around Croydon and South London www.tranquilbirth.co.uk
