Are natural childbirth classes a waste of time?

Laura Timmins was determined to have a natural labour.

She attended antenatal classes with a top childbirth guru and booked into a prestigious private birth centre in London – at a cost of more than £5000. ‘I was adamant I was having a natural birth and almost felt I was entitled to one, given how much I was spending,’ says Laura, 32, who works in the film industry. ‘For this reason my birth plan was absolutely rigid. My baby would be born in a pool, no matter what. I was convinced it wouldn’t really hurt and was rather looking forward to it.’

But when doctors found Laura’s baby was small for dates and feared there were problems with her placenta, they advised she be induced on her due date. ‘My body reacted very strongly to the hormone pessary I was given to start labour,’ says Laura. ‘I dilated 10cm within an hour and felt breathless, scared and unable to think straight. Jessica was finally born with help from a surgical cut and a ventouse. I spent the first hour of her life being stitched up thanks to the episiotomy. So much for a natural delivery.’

Reality Bites

A ‘natural birth’ is widely defined as one that doesn’t involve any intervention, such as caesarean, induction or pain relief (although gas and air is generally categorised as natural). And, it seems, the quest for such a delivery is rising among today’s mums-to-be – a search for ‘natural childbirth’ on the internet today brings up 713,000 sites. Amazon has 600-plus books for sale on the topic.

However, while many pregnant women are attracted to the idea of natural childbirth, putting that into practice is a very different matter. One study, published this summer in the International Journal Of Obstetrics And Gynaecology, followed more than 1000 pregnant women in Sweden. It found those who had special preparation to help them give birth naturally – including breathing, massage and relaxation therapy – were no more likely to have a ‘natural birth’ than those who hadn’t. The proportion who went on to have epidurals was exactly the same, while the caesarean section rate was 20% in the group that had been through the natural technique classes and only 21.5% in the group that hadn’t.

‘The findings of this study are contrary to what many of us would expect,’ says the Journal’s editor-in-chief Professor Philip Steer. ‘The lack of any benefit from psychoprophylaxis [breathing and relaxing] techniques is disappointing. It suggests that mums are affected more by their personality and previous experiences of pain and childbirth than by the relatively limited training that is possible during pregnancy.’

This research comes as no surprise to Emily Cainer, 30, from Sheffield, who found herself begging for an epidural when she was in labour with her first child, despite her birth plan. ‘Throughout my pregnancy I went to yoga classes,’ she says. ‘For my birth I wanted to breathe properly and use positive imaging, where you picture a positive outcome and focus on achieving that. But once my labour started I was just floored by the pain. It was like nothing I’d ever experienced. My natural childbirth teacher had mentioned “positive pain”, but, when it came down to it, I discovered I wasn’t a big fan of pain – positive or not.

‘After three hours I asked myself why I was being stubborn. So I requested an epidural,’ says Emily. ‘Holly was born two hours later, with no extra help. You can do all the preparation you like, but when you are giving birth to an 8lb 2oz baby, that preparation can quickly feel like a distant memory.’

Mother Nature

There are doubtless many women who share Laura’s and Emily’s experiences. However, in equal measure, plenty believe natural birth preparation played a key part in their babies being born without hardcore pain relief or assistance from equipment such as a ventouse.

Elsa McTierney, 37, is a mum of two from Edinburgh. ‘During my pregnancies, I took weekly yoga and active birth classes,’ she says. ‘The yoga was great because it taught me to hold difficult poses using breathing to help me through pain – slightly agonising, but useful preparation for the real thing.

‘Active birth classes were all about positions for birth and being informed about what to expect. My babies were both born without medical intervention. The classes really helped: I felt fit, able to concentrate and in control.’

Meanwhile, contrary to the findings of the Swedish study, Anna Starkey, 29, from Birmingham, is convinced that the breathing techniques she learned at her natural birthing classes laid the foundations for her good labour.

‘It’s easy to breathe shallowly and end up gulping for air when you give birth,’ she says. ‘But when you remember to breathe deeply and slowly, as the classes teach you, it helps you to feel in control of the contractions. My labour was fine – seven and a half hours – and I only needed gas and air.’

Janet Balaskas is a renowned pioneer of natural childbirth. She founded the Active Birth Movement, which argues a woman should be led by her body during childbirth, adopting upright positions during labour and delivery. ‘A natural birth gives a woman a huge sense of achievement,’ she says. ‘It helps her to bond with her baby and she’ll recover more quickly than if she’s had intervention.’

Balaskas says she is not surprised by the results of the Swedish study, adding it’s birth position rather than just breathing and relaxation that affects the outcome. ‘A calm, private, non-medicalised environment is crucial in a natural birth, as well as the mother’s freedom to move and choose her most comfortable positions,’ she says. ‘We focus on remaining upright, which helps a woman’s pelvis widen to the shape of the baby’s descending head and improves blood flow to the baby and placenta. It’s easier for a woman to give birth when gravity is working with her, rather than against her, such as when she’s lying on her back.’ According to Balaskas, more than half of the women who attend her active birth classes go on to have a natural delivery.

Heat of the moment

Even within the natural birth community, there is an understanding that, despite best intentions, the ideal scenario may not happen. Dr Yehudi Gordon is an esteemed obstetrician, author of Birth And Beyond… (£25, Vermilion) and a long-standing advocate of natural birth techniques. He accepts that circumstances can overtake a woman’s desire for natural birth. ‘I’ve been at hundreds of wonderful natural deliveries,’ he says. ‘But I also know there are times when medical intervention is necessary and even life saving.’

Gordon also accepts there are all sorts of pressures that lead a woman to opt for medical intervention or pain relief. ‘Often the hospital’s environment is geared up to promote, and even expect, a woman to have pain relief,’ he says. ‘It is also often hard for a woman’s partner to stand by and see her in pain and he often influences a woman to ask for intervention. Labour can be a very confusing time.’

Both Gordon and Balaskas agree that, while natural birth is desirable, it’s important to remain open-minded. ‘We would like women to know they are designed to give birth,’ says Balaskas. ‘If there have been no complications in pregnancy and the mum-to-be is low risk, there is no reason why she shouldn’t be able to give birth naturally. On the other hand, a woman shouldn’t be coerced into natural birth, as sometimes intervention is medically necessary. What’s paramount is the safe delivery of the baby.’

Back to school 

So is it worth shelling out all those extra pounds on childbirth classes? While the jury is still out on the ‘natural’ variety, all experts agree antenatal classes are generally an excellent idea – whether at your local NHS hospital, NCT classes or Active Birth Centre. ‘Antenatal classes can boost the confidence of a mother and her partner,’ says Professor Cathy Warwick, general secretary at the Royal College of Midwives. ‘And classes do more than focus on breathing and relaxation techniques. They allow mothers to develop a support system and learn about becoming a parent.’

NHS midwife Breedagh Hughes agrees. ‘Giving birth for the first time is almost always a very steep learning curve,’ she says. ‘But the more you can find out beforehand, the better. It’s great to get support from professionals and other mums. No, it may not all go exactly to plan, but if you know what to expect you’ll feel more confident on the day, no matter what happens.’

And confidence has proved vital for many women who feel satisfied with how their birth turned out. ‘I had an epidural so I did deviate from my birth plan,’ says Emily Cainer. ‘But the classes I went to helped me feel in control – I knew what might be happening next. They also talked me through my options, so I knew the difference between an epidural and pethidine, and understood what was happening to my body. What antenatal classes give you psychologically is as good if not better than what they offer you physically,’ she says. ‘I also made some brilliant friends who’ve helped me with motherhood. Antenatal classes prepared me for giving birth, naturally or otherwise.’