Prenatal education usually means that you learn about birth, recovery, and baby care while you’re pregnant. There are so many different ways to do this. We are lucky to live in a time where information is at our fingertips. However you learn best, you can find a way to get the information.

Why is prenatal education important?

There has been a lot of research investigating this question. Does it actually help people to take classes while they’re pregnant? And how?

It seems pretty clear that it does help. The research evidence does vary on how and how much though. Some research shows that perinatal education can lower risks for pregnancy and birth complications, improve birth outcomes, lower cesarean rates, improve the way people feel about their birth experiences, and increase breastfeeding rates. Successful outcomes depend on a lot of factors, but you should feel confident that you are doing a good thing by getting this kind of education.

The type of class matters too! Some classes provide you with more or better information than others. It’s important to explore your goals before choosing a class. If you want to have an unmedicated birth, you should take a class that focuses on that. If you know you will be having a C-section, there are classes to help you prepare for that. If you know you want to breastfeed your baby, you should definitely get prepared by taking a class so it can be an easier transition for you. If you know you have to go back to work very soon after having your baby, you might want to take a class to learn about pumping your breast milk.

There are so many topics and options out there, it can be hard to decide. I think the best thing to do is decide what your overall vision is for your childbearing year, and then find the classes that can help you achieve it. Then find the kind of class that you think will be the most fun and convenient for you so that you can learn best and enjoy it.

How to Get your Prenatal Education

There are definitely benefits and drawbacks to all of the different ways of learning and methods for education. There are so many types of classes out there!

• Private classes.
• Public classes offered by varying health authorities or non-profit organizations such as WIC.
• Hospital based classes taught by nurses or educators.
• Education offered in OB, midwifery, or doula practices for their clients as part of their prenatal care.
• There are also some hybrid offerings out there. Breastfeeding Success is a great example of this. We are a private company, but we also partner with some local hospitals to provide services to their clients. Because we are an in-network care provider, we can also help people get their perinatal education covered by insurance and we can offer financial assistance although we are not a non-profit.

There are also different levels of expertise when you’re considering which teacher to choose. There are…

• Certified instructors. For example, for childbirth education, there are many different paths to certification, but their training is specifically geared toward providing childbirth education. These instructors can choose who to train with for their certification depending on their own interests and who and where they plan to teach.
• Professional instructors. These are not necessarily trained educators, but people in different professions like nurses, doctors, midwives, doulas, or lactation consultants who offer classes in an area that they specialize in. For example, a labor and delivery nurse might offer childbirth education classes at their hospital, or a lactation consultant might offer breastfeeding or pumping classes.

It’s also a great idea to consider the particular “method” an instructor might be offering. At Breastfeeding Success we take a very universal and evidence-based approach to education and try to include a little of everything in our offerings. Our instructors work to stay up-to-date and relevant, so that you can have the best information possible.

Some people like to choose a very specialized approach to their education. Childbirth classes are a great example of this. Some people want to have an unmedicated birth, so they would choose from methods that can help support that goal. You might choose a Lamaze class for a more general “natural” approach, or Hypnobirthing if you are a person who values meditation and deep focus. Or you may choose Bradley Method classes if you have a very involved partner and like the idea of a coach-focused method. Those are just a few of the MANY methods for learning about childbirth!

How to Receiving Training

And then you need to consider how you’ll show up for class.

Live virtual classes are taught by a live instructor just like an in person class, but it’s all done online. They meet using Google Meet or Zoom or another similar platform. You can see the instructor and possibly some of the other students. You can interact with the instructor and the other students by using a chat box or by using your microphone to speak. The instructor is most always on camera and you can see and hear everything.

Sometimes instructors will use physical teaching tools to illustrate concepts and support your learning. For example, I have a model of a pelvis and a baby doll that I use to show how birth works. I hold it up to the camera so everyone can see. A lot of instructors might also use digital teaching tools like a slide presentation, videos, or digital whiteboards to help with the teaching.

• Benefits:
  • This is a very convenient way to learn because you don’t have to travel or do much to prepare. You just turn on your computer or even just your smartphone, and you’re in class. You can take a class from anywhere in the world using this technology.
  • You might be better able to focus on the class content in this kind of class. Some people find it hard to focus in a room full of other people.
  • You can get very comfortable in your own bed if you want to! You can move around, have your own snacks, keep the temperature just the way you like it.
  • If there is a pandemic, you can’t get sick by taking a virtual class!
  • If you have children, you might not have to worry about getting childcare if you’re taking a virtual class at home.
  • These are sometimes less expensive than in person classes.
• Drawbacks:
  • Some people already spend too much time in front of a screen and do not want to take a class that involves more time at a screen.
  • Some people have trouble focusing unless they are physically in the same room with the teacher and students.
  • Especially if you are an extrovert, it also just might not be as fun when you can’t interact with other people. It’s often true that students don’t turn on their cameras for class, and it can be hard to connect with the people in the class or even feel like there are other people there.

In person classes are taught in an actual physical classroom. There is a teacher and there are other students in the same room with you. This is how most of us experienced school, until recently! Depending on the teacher, there might be a lot of props and visuals to illustrate concepts and help you learn. Like the virtual classes, there may also be a slide presentation to go along with the lesson and even videos and whiteboards.

• Benefits:
  • You get to meet other people who are pregnant, and it’s likely they live nearby. People can much more easily develop friendships and community by going to in person classes and groups.
  • Some people learn better this way. If you have trouble focusing on a screen for too long, this might be the way to go.
  • If the class is at your hospital, birth center, pediatrician’s office, or a place that it can help to get familiar with, you can benefit from knowing the location better.
  • You might feel like it’s easier to ask questions and get the information you need in this format.
  • Taking a class with a partner can be a great way to have a night out doing something new and different from the usual date night. It can be a great way to connect.
  • If you have children, it can be a good excuse to take a little break and get some self-care in.
• Drawbacks:
• • You have to travel to the class. That might mean fighting traffic, burning a lot of gas, dealing with frustrating parking situations, etc.
  • It means more time away because of the travel, so if you have a very tight schedule, it might be more difficult to fit it in.
  • If you have children, you will likely have to find childcare. That can be too expensive or too complicated for some people.
  • The classroom setting might not be comfortable for you. Sometimes it means hard and uncomfortable chairs, or the room is too hot or too cold, or you have to sit next to someone who can’t stop coughing!

Online classes are ones that you can purchase and complete on your own time. These can usually be purchased online, and then you receive access to the course via a link. It might be a multimedia class experience that includes handouts, videos, assignments and activities along with recorded instruction or without. It might also be a recording of an instructor going through the entire course with you. These might include a lot of information and be very long, or they might be very simple and short. There are a lot of options out there for these types of classes and they range greatly in quality and cost.

• Benefits:
  • You get the information on your own time. If you are getting REALLY close to your due date and can’t find a class to fit in before your deadline, this might be the best way to go. If you have a very complicated schedule, this might also be a good option for you since you can complete it whenever you have time. You can also take as many breaks as you need and you don’t have to worry about interruptions.
  • These are often offered at a lower cost than live taught classes, although some of them can still be quite expensive.
  • There are a lot of options for online classes!
• Drawbacks:
  • Most people don’t finish them. It can be hard to stay motivated when you’re not accountable to anyone for your attendance.
  • It might be less entertaining. Without the live interaction, many people find they get bored with this kind of learning.
  • You don’t get to ask questions, so you might be left needing to know more.

Hybrid classes use a combination of methods for providing the information. You might meet in person for one or more of your class sessions, and virtually for the rest. The class might also be completely online. In this case, you might have one or some live virtual meetings and then do the rest of the class on your own time by watching videos or completing assignments.

What is Prenatal Education Exactly?

What do you want or need to learn about? Prenatal education might include some or all of the following topics:

• Childbirth
• Breastfeeding
• Newborn care
• Healthy pregnancy or prenatal care
• Child or infant development
• Infant sleep
• Postpartum recovery
• Self-care/mental health
• And there are other topics related to health and parenting to learn about too!

If I could give everyone COMPREHENSIVE and complete prenatal education, I would. Of course, as a parent, childbirth educator, and the manager of a Parent Education Program, I would say that! There is so much to know when you are expecting a baby for the first time.

You want to consume as much information as you can. You might feel like this will help guard against problems. Or you might just want to go with the flow and just see what happens.

I think a healthy approach is to do as much as you need to lower your stress levels and feel confident. This might mean doing nothing, or this might mean doing EVERYTHING. For most people, it’s somewhere in the middle. Getting some information does make most people feel more prepared and confident. You also don’t want to go overboard though! Knowledge can’t guarantee a perfect outcome. Try to avoid too many Google searches, and if reading every book on the shelf is just making you feel like you need to read more, you’ve probably done too much. That’s what prenatal education is great for. If you can take a few good classes and leave it at that, you’ll probably feel better, be prepared, and even increase the probability that everything will turn out great.

Below is a recorded interview with Omaira Hanif, RN, IBCLC. Omaira works mostly with people immediately following birth. She works in the hospital setting as a lactation consultant (IBCLC). She is highly trained in the clinical management of lactation and helps people get a good start. Omaira is also a nurse who visits new families in their homes. Her job is to check on the babies, new moms, and the family, but also to educate. She spends a lot of time explaining what is normal and when they might need extra help.

Omaira is also a teacher! She teaches a breastfeeding and newborn care class. She feels very strongly that all families would benefit from prenatal education. She has noticed that when families have received some education about breastfeeding and newborn care, they don’t need her help quite as much after the baby arrives! Although she loves to be needed, she most of all wants parents to succeed while feeling confident about their own abilities.

Citations showing benefits of prenatal education:

• Quoted from Pregnancy Risk Assessment Monitoring System Survey “According to NJ PRAMS data, NTSV mothers who took a childbirth education class were 30% less likely to have a C-section and 3.7 times more likely to initiate breastfeeding compared to NTSV mothers who did not participate in a class, after adjusting for race/ethnicity, education, insurance payor type for delivery, and knowledge of risks/benefits of C-section versus vaginal delivery.”
• Mueller CG, Webb PJ, Morgan S. The Effects of Childbirth Education on Maternity Outcomes and Maternal Satisfaction. J Perinat Educ. 2020 Jan 1;29(1):16-22. doi: 10.1891/1058-1243.29.1.16. PMID: 32021058; PMCID: PMC6984379. Quoted from the study findings. “Attendees of a childbirth class were exclusively breastfeeding at a rate of 95% versus 78% of non-attendees.”
• Zafman KB, Riegel ML, Levine LD, Hamm RF. An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial. Am J Obstet Gynecol. 2023 Jul;229(1):67.e1-67.e9. doi: 10.1016/j.ajog.2023.04.007. Epub 2023 Apr 11. PMID: 37054807; PMCID: PMC10330277. Quoted from the study findings “Patients in the intervention arm were more likely to breastfeed at delivery.”
• Yohai, David, Alharar, Debi, Cohen, Ruthi, Kaltian, Zohar, Aricha-Tamir, Barak, Ben Aion, Saviona, Yohai, Zehava and Weintraub, Adi Y.. “The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes” Journal of Perinatal Medicine, vol. 46, no. 1, 2018, pp. 47-52. https://doi.org/10.1515/jpm-2016-0345. Quoted from the study findings “Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls.”
• A Guide to Effective Care in Pregnancy and Childbirth (3 edn); Murray Enkin, Marc Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett, Justus Hofmeyr; Published: June 2000

DOULA is an ancient Greek word that means female slave or servant. Yikes, right?!?!

Some more modern interpretations of the word accept the meaning as woman caregiver. In modern times, being a doula is a profession. A doula is a birth companion.

Birth doulas are hired to provide CONTINUOUS labor support. Postpartum doulas offer support AFTER your birth during the recovery period. Some doulas do both. They are called Full Spectrum Doulas. A lot of modern day doulas might actually consider themselves female servants in the most literal way. They are there to serve the woman. Most people don’t hire a doula or have even heard of a doula, but they do provide an essential service.

What Doulas are NOT

Doulas are not medical practitioners. A doula should not do any medical procedures or even offer medical advice. A doula also can not speak for you. A doula can find out a lot about you and understand your preferences and plans for your birth, but they can not step in and make medical care decisions on your behalf. A doula can offer you general information about birth related procedures and topics and offer you resources and referrals, but really should not make recommendations about your healthcare.

Doulas are also not babysitters or nannies. A doula is trained to support the pregnant, laboring, or postpartum woman. They are the doulas’ focus. A pregnant, laboring, or postpartum person needs plenty of support, and most often they don’t get enough. Babies are adorable, but they have parents AND other caregivers.

How Doulas SERVE

A doula knows a lot about pregnancy, labor, birth, postpartum recovery, and possibly even about baby care. They learn some of this from books and training, but they also know this from having the experience of being with other people on this journey. It’s usually a very deep and personal understanding.

Doulas usually feel called to the profession. Most doulas don’t do it for the money or the glory because there isn’t much of either! Most doulas are completely awed by and obsessed with pregnancy and birth. It’s a fascination that might have been sparked by their own birth experience or that of a loved one, or they might have been born with their passion!

The spark is usually fanned and fueled by a deep desire to help. Doulas understand what a special and complicated time pregnancy and birth and new parenting are in a person’s life, and they feel compelled and honored to help and participate in some way. Doulas also understand that the modern birth experience is often cold, disconnected and scary. They want people to feel nurtured, safe, and informed so that they can experience the joy in the process and the outcome.

Birth doulas help by:

• Being a touchpoint during pregnancy. A doula will listen and offer answers or referrals or moral support when you have issues or questions.
• Providing education. Some doulas will offer some childbirth preparation as part of their services.
• Making a birth plan. Some doulas will encourage you to make a birth plan and even help guide you through the process.
• Being on-call and showing up for labor and birth. Your doula will stay available for the time around your due date and make sure to answer your call when it’s time! They might come to your home or meet you at your hospital or birth center depending on the situation.
• Providing physical support for labor by offering touch or massage or help you get into more comfortable positions. They will encourage you to breathe effectively and stay well hydrated. They can make recommendations for how to position or move your body so your labor continues smoothly and with less pain.
• Providing emotional support. Labor and birth can be hard. A doula usually knows the right things to say and do at the right times to keep you feeling motivated and calm. They can help you understand that what you are experiencing is normal and that everything is OK.
• Being an advocate. A doula can not speak for you, but a doula can remind you and your care team about your birth preferences. If a problem comes up, a doula can’t make a decision for you, but they might be able to offer you information so that you can make a decision for yourself. A doula can be very observant about what is happening, and can bring your attention to anything that you might need to know about. “It looks like they’re about to cut the cord. Didn’t you say your partner wanted to do that?” A doula can help your partner to advocate for you when necessary. Your partner or family member can often speak for you when needed, and a doula can help them if they don’t remember some of your birth preferences or need more information. They can help you AND your partner know what questions to ask and how to advocate for yourselves.
• Facilitating communication. During your prenatal care, a doula can help you know what to ask about during your visits with your doctor or midwife. A doula can help you make respectful requests of your caregivers when needed. They can help partners communicate more effectively with each other so you can stay on the same page and set up healthy expectations.
• Helping your partner know how to best support you.
• Supporting your partner by giving them time and ideas for rest and rejuvenation. When your partner stays healthy, they can continue to offer good support for you.

Postpartum doulas help by:

• Offering some information and referrals (if needed) about baby care and feeding.
• Providing some baby care when you need to shower or get some self-care time.
• Helping you eat well.
• Helping you get plenty of rest.
• Doing light housework.
• Teaching you about your body changes and how to manage your recovery.
• Providing emotional support and comfort when things feel very hard and overwhelming.
• Offering information and referrals about complications that might come up during postpartum recovery including mental health issues.
• Being a touchpoint during your postpartum recovery. They can help you understand that what you are experiencing is probably normal and will pass. You are OK.

The Benefits of Doula Care for Birth and Beyond

Most people who have had doula care understand the benefits. I have very rarely heard someone say that they regret hiring a doula. Most people say the opposite. They can’t imagine having done it WITHOUT their doula.

Some people give birth without a doula first, then get a doula with a subsequent pregnancy. Most of these people say they wouldn’t do it again without a doula. It’s easy to hear THAT doulas are helpful, but HOW doulas are helpful is a lot harder to understand. Most people can’t really articulate WHY their doula was so important, just that she was essential. I also can’t tell you exactly why my favorite shoes are so helpful. I don’t know what it is about the design or features of these shoes that make them so special to me. I just know that when I don’t wear them, life is worse. My feet hurt. My ankles hurt. I’m just not as comfortable or energetic when I wear other shoes. A doula is sort of like having a really good shoe. Maybe it doesn’t sound all that glamorous, but it’s life-changing!

There is very clear and legitimate research showing that doulas actually make a very measurable difference in birth outcomes.

Research shows that doula care can:

• Significantly lower the risk of having a cesarean birth.
• Lower the risk for postpartum depression and other postpartum mood disorders.
• Lower the use of epidural medication.
• Make it more likely that people rate the birth experience as good.
• Increase the chance that people feel they coped well with labor.
• Make it more likely that people report that “labor had a very positive effect on their feelings as women.”
• Help people have improved perceptions of their bodies’ strength and performance.
• Increase breastfeeding success rates.

This is a HUGE and very significant list of benefits, and the word is spreading. Doula care is not universal, but it’s there! Many cities have a thriving doula community and there are plenty of doulas to contact and interview and hire. In other places, there are only a few. Doula care is usually not very expensive when you consider the amount of time a doula spends with you. Also, consider the fact that they have to reserve about a 2-week window around your due date to be on call for your birth.

Even so, doula care might not be in everyone’s budget. While doula care is not currently covered by most insurance plans, some are coming around. It seems like a no-brainer that insurance companies would want to cover a service that can have such a huge and lasting impact on maternal health.

Currently, Tricare covers doula services, and there are a few others. Rhode Island passed legislation REQUIRING doula coverage for both Medicaid AND private insurance providers. Nine states including Oregon, Minnesota, New Jersey, Florida, Maryland, Nevada, Michigan, D.C., and Virginia currently reimburse Medicaid clients for doula services. At least 17 other states are planning to implement something similar for Medicaid reimbursement. Five states are considering a Medicaid sponsored doula program. There is a pilot program in Texas that includes Austin through G.A.L.S., which is covering the cost of doula services for Medicaid clients. There are programs like G.A.L.S. Austin or Black Mamas ATX which provide low-cost or no-cost doula services for those who can’t afford to hire a doula out of pocket.

Another option to make doula care more affordable for you would be to hire a doula-in-training. To become fully certified, most doula certification programs require a student doula to attend at least three births. This means that the doula has taken the classes and done the reading and fulfilled other requirements, but now they have to get out there! They will probably need the clients and medical staff attending the birth to submit a short evaluation about the care they received. It can be hard for doulas to get invited to births before they’re actively working, so most doulas-in-training offer a very reduced rate for their certification births.

Doulamatch.net is a nationwide doula directory where you can see many of the doulas in your local area. The doulas can show that they have a certification. Doulas-in-training are easy to spot, because they lack a certificate verification and have no or limited experience. In my hometown of Austin, TX, the Central Texas Doula Association is another great way to find a doula.

If you do not have access to doula care for lack of availability, budget, or any other reason, your partner or another family member or friend can step in. Doulas are shown to offer the most benefits, but continuous labor support of any kind is beneficial. I would recommend getting some education about how to support someone through labor, so that your partner can provide the best support possible. We have a class for that! Birthing Partner Prep: The Manual For Labor and Birth Support. Another great resource is a book called The Birth Partner by Penny Simkin.

Resources

• Doula care across the maternity care continuum and impact on maternal health: Evaluation of doula programs across three states using propensity score matching
• Effects of providing hospital-based doulas in health maintenance organization hospitals
• Impact of Doulas on Healthy Birth Outcomes
• Doula care supports near-universal breastfeeding initiation among diverse, low-income women
• Doula Services in Medicaid: State Progress in 2022