Reinventing Childbirth Classes: Low-Cost Care, High-Quality Results

These groups may be at the leading edge of a 21st century attempt for women to regain control of maternity care.

New pregnancy groups are replacing traditional childbirth classes.
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By the time Trina Millenheft gave birth to her eighth child in 17 years, one might have thought that she knew everything a woman could know about having a baby. She thought so, too.

So when her certified nurse midwife, Hillary Handlesman of La Clinica in in Medford, Ore., who attended the December 2012 birth of Millenheft's youngest son, suggested she get her prenatal care via a group called CenteringPregnancy, Millenheft, 42, thought something along the lines of: What can a group of pregnant women tell me that I don't already know?

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It turned out that she did learn a thing or two, like that magnesium supplements could help her control headaches during pregnancy. She also found that she loved going through her pregnancy with other women who were going through the same thing.

Birthing classes, all the rage about 40 years ago when many women felt labor and delivery were becoming too medicalized, are plummeting in popularity. Only one in three mothers takes childbirthing classes, according to a 2013 survey by Childbirth Connection, an organization providing evidence-based maternity information; 59 percent of first-time mothers take the classes, compared to only 17 percent of women who have previously given birth. That's down from an overall 70 percent of women who took such classes in 2000. "It's distressing to me that childbirthing classes are not routinely offered any more," says Diana Mason, professor of nursing at Hunter College in New York.

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With 67 percent of mothers receiving an epidural, a local anesthetic that blocks the pain of contractions, it's not surprising that many women don't feel the need to learn, for example, breathing techniques aimed at reducing the pain of contractions. One in three women has a surgical delivery, or Cesarean section, again making many women feel they won't need to understand how to manage the pain that goes along with a vaginal delivery. And let's face it. With more than two-thirds of women working throughout their pregnancies, who has time for childbirth classes? Instead, expectant mothers get information from television, from friends and family, from books and from the internet.

The information can be alarmist, contradictory and just plain wrong. The lack of information no doubt contributes to a U.S. maternity process that seems like a conveyer belt to medical intervention—and the highest costs in the world to deliver a baby.

About 20 years ago, Sharon Rising, a certified nurse midwife and creator of what is now a national program called CenteringPregnancy, found that during pregnancy women gravitated toward the company of other pregnant women. Before starting the program, she did a lot of traditional one-on-one prenatal care. "One woman's question was another woman's question. I was repeating myself all day long," she says. "And who really has the wisdom here? The women do."

Today, there are 135 certified CenteringPregnancy groups throughout the country, with another 60 in development, and other non-certified programs that mimic many aspects of group prenatal care. Women in the groups, generally eight to 12 of them, meet on a traditional prenatal schedule—about 10 meetings per pregnancy. With the privacy of a screen, the midwife listens to the fetal heartbeat or does an exam if necessary.

A routine check-up that would take 10 or 15 minutes in a doctor's office becomes a two-hour meeting in which women share experiences like leg cramps, or having sex during pregnancy, or what kind of diapers to use, or their feelings about circumcision. They also talk about the pros and cons of pain medication and about their fears of too much medical intervention. "These can be touchy conversations. But we spoke very freely," says Jennifer Kuelz, 41, who had her first child after attending group centering classes with Group Health Cooperative in Bellevue, Wash. "It was nice to have constructive conversations about things we were all considering at the same time."

An earlier version of this story misstated that Jennifer Kuelz had a C-section after her water broke prematurely. She had a natural delivery.

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