Pain Management Series: Childbirth Education for Pain Relief during Labor



hi everyone in today's video we're going to talk about childbirth education for pain relief during labor hi everyone my name is Rebecca Decker and I'm a nurse with my PhD and the founder of evidence-based birth this video is part of our pain management series we're but we've been focusing on different ways to help manage pain during labor and today we're going to focus on the effects of childbirth education specifically its effects on pain childbirth education is often called antenatal education in other countries and its overall goals are pretty broad the goals of childbirth education can range from increasing your self-confidence helping you prepare for birth helping your partner learn how to support you during birth and helping you prepare for parenting and breastfeeding another common goal of childbirth education is to help you form a social support network and to meet other parents in your community who are going through the same thing so how might childbirth education work to relieve pain during labor researchers think that childbirth education might work by changing how you perceive pain during labor in other words decreasing the unpleasantness of pain if you haven't watched it already I recommend that you go back and watch our overview of pain management video which is the first video in this series in that video we talked about several different mechanisms that can act on pain so that your brain interprets it differently or is less able to interpret it as pain the theory is that childbirth education acts on your central nervous system to relieve pain we call this the central nervous system control method of pain management and basically what this means is that acquiring knowledge and skills before you give birth may activate thoughts and mental processes in your brain so that you perceive less pain or your pain feels less unpleasant during labor so how many people take childbirth education classes the last research we have on this in the United States comes from the listening to mother study which was published in 2013 in that study they found that roughly one in three mothers who gave birth in the United States hospitals had take again some kind of childbirth preparation course roughly 59% of first-time mothers had taken a class before they gave birth to a baby that year compared with 17% of experienced parents one in two mothers took a class either with that pregnancy or with a previous pregnancy this means that in the United States only about half of parents ever take a childbirth education class before they have a baby of those who took a class about half took a class that met every week for a period of several weeks one-quarter took a class in one day and one-quarter took a class over two days the major focus of most birth classes tends to be on the labor and birth process basically just describing how the process works what to expect when you go to the hospital is the focus of about 29% of classes and this theme was most common in the one-day childbirth education classes care options and benefits and harms of those different options was the theme and about 20% of classes most people in the United States take Hospital based classes researchers have found that hospital based classes tend to serve clients with a diverse array of goals and values and that some Hospital classes condition you to accept the hospital routines some hospital childbirth educators also sometimes feel pressure to not teach the full range of options others say that that's not a problem on the other hand about 18% of people take a childbirth cost from an independent educator who is not affiliated with a hospital research shows that these classes tend to teach people to be critical consumers of their health care and they also tend to focus on the normal birth philosophy in helping you prepare to have as normal a birth as possible in an earlier listening to mothers survey that was published in 2007 researchers found that after a typical childbirth class more parents had more trust in hospitals and less fear of medical interventions they also had a greater trust in their caregivers and almost all of them wanted to be informed about the major benefits and risks of different interventions such as inductions or cesarean but the majority of them could not answer questions correctly about these interventions even after they'd taken a typical child birth class a common philosophy today among child birth educators is to say something like this I don't believe in advocating for a certain way of giving birth I simply believe in the parents right to make an informed choice this philosophy sounds really wonderful in most childbirth educators that I know would say that they believe in that philosophy the problem is as Judith Lawrence says in her really well-written article about childbirth education is that in many hospital settings around the world choice can be an illusion this means that parents may educate themselves about their different options and their childbirth educator may encourage them to learn about these options but if they're entering a hospital system where there's a very heavy emphasis on following institutional routines and traditions it might be very difficult if not impossible for parents to access all of these options so what is the evidence say about the effects of childbirth education on pain the truth is up until this point we have not had a lot of research evidence to guide current and future childbirth education efforts there are very few randomized controlled trials on childbirth education and for one reason is because it's very difficult to conduct randomized trials on this topic a lot of people have strong feelings one way or another about whether or not they want to take a childbirth class and so they might not agree to be in a study where they're randomly assigned to either have childbirth education or nothing and some people might feel that it's unethical to assign people to no education also every top birth cost is different there are unlimited numbers of childbirth education programs out there all with different strengths and weaknesses so one randomized trial about one educational intervention well that education might be so different that you can't compare it to the other classes that are being offered in your community also chareth education does not exist in a vacuum and what I mean by that is that like I said earlier you can take a childbirth class and be educated about all your options and be prepared to use them but if you walk into a setting or you have a provider who is not truly supportive of those choices that you've made you might find yourself backed into a corner and not able to access those options that you hated yourself about for example some of the classic studies on Lamaze childbirth classes these studies took place in the 1970s even though the women were educated that episiotomy czar not necessary and may be harmful nearly all of the women in those studies had episiotomies and that's because of something that we call the provider effect in other words if you have a provider who was not supportive of your goals and wishes and there's a mismatch between what you want in your provider wants the pz atomy could happen regardless of whether or not you wanted it or consented to it which is a totally different topic for a different video if you want to learn more about that topic I would recommend googling the words obstetric violence so anyways that's why it's so difficult to find research on childbirth education there was a Cochrane review published in 2007 where researchers tried to combine several randomized control trials in that systematic review they found a total of nine randomized trials with a little more than 2,000 participants in 2011 they did post that they had found a 58 additional trials that were waiting classification meaning they haven't gone through them yet to decide if they're gonna put them in the next review but so far they haven't included any of those studies yet in an update the few studies they were able to include in this 2007 review came from the United States Canada and Iran each study tested a completely different educational class for example in one study they focused on just providing 30 minutes of class about the stages of labor and in another study it focused on teaching fathers parenting techniques the Cochrane researchers were not able to draw any conclusions from these studies because the studies themselves were so different and they all looked at different health outcomes in 2015 a different group of researchers looked at 17 randomized trials from Western countries again they had the same problems as the Cochrane researchers they could not draw any conclusions because educational classes were so different some classes just provided one or two hours of content others provided up to 48 hours of classes and so the reviewers basically said we can't draw any conclusions about the effectiveness of childbirth education there was however a randomized control trial that came out in near 2016 from Australia that seems to be really important so I want to spend the rest of my time talking about that study in this study two hospitals in Australia work together to randomly assign 176 first-time mothers to either have a comprehensive two-day childbirth class based on the she birth techniques or standard care which consisted of the typical Hospital childbirth class in the control group that was assigned to the typical childbirth class at the hospital this class was mostly descriptive focusing on stages of labor how do you know when Labor's beginning when do you go to the hospital as well as parenting and postpartum issues the control group in this hospital class was not instructed to practice any techniques at home and when they surveyed them after the birth they found that none of them did practice any comfort measures techniques for labor at home the intervention group got a two-day childbirth education course based on the Shi birth principles that included six different non drug comfort measures for labor these comfort measures included acupressure visualization and relaxation breathing massage yoga techniques and helping your partner learn how to support you through labor the classes for the intervention group took about 14 to 15 hours to complete total and there could be anywhere from 2 to 12 couples in the class with an average of eight couples per class these couples were encouraged to practice the techniques they learned at home and on average they found that they practiced 13 techniques per week until the birth of their baby the researchers primary goal was to look at the rate of epidural use in both groups they found the only 24 percent of people who had the she birth course had an epidural compared to 69 percent in the traditional standard care group that got the typical childbirth class the intervention group also had a significantly lower rate of pitocin augmentation and caesareans they also had a shorter second stage of labor on average fewer cases of perineal trauma and fewer cases of their newborn needing to be resuscitated this research study is open access and I encourage you to read it because it's really interesting they going to give some more information about what the intervention group found was most helpful so the people who had the more in-depth childbirth class that covered all of these comfort measures and encouraged them to practice the most common technique that the women used during labor that they felt was helpful was something called a blissful belly breath 60 percent of people who had the more intensive childbirth class used this technique other techniques that a lot of them used included massage acupressure and visualization also 35% of people in the she birth class used a technique called gentle birthing breaths that helped them slow down the birth of their baby on average the people that had the more intensive childbirth class reported using at least four techniques during labor in contrast less than 5% of anybody in the control group reported using any of the techniques that were taught in the more intensive class so this study shows that childbirth education that focuses on non-drug comfort measures complimentary and alternative therapies such as conclusion systematic reviews have not been able to summarize the research evidence on this topic or provide strong evidence for child birth education because every study that looks at childbirth education is so different that we can't lump or pull them together high-quality evidence on childbirth education is lacking and so the effects of each type of childbirth class is generally unknown it's not that Tom birth education isn't being studied it's that each research study is so different that we can't combine them together to get a stronger result it's also difficult to study child birth education because choppered education does not exist in a vacuum if you tried to replicate the Shi birth study from Australia for example in the hospital that is hostile or unsupportive of women choosing non-drug comfort measures it might be very difficult for family members to actually use the techniques that they were taught I think the time has come for more child birth education programs and more child birth educators to team up with researchers to get more research evidence on this topic so that we can figure out what is the best way of teaching parents what are the most effective ways and how can we also change hospitals around the world to make them more accepting of parents who want to use non-drug methods of pain management so that's it for this video about the effects of Tom with education on pain management I'd love to invite you to subscribe to our Channel and to also check out the rest of our videos on pain management during labour we also have a series on natural induction method thanks everyone bye to learn more and subscribe to our newsletters for useful information please visit Evan and spaceburn scone

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