The BBC is reporting on a new study about the effects of childbirth education classes that emphasize breathing and relaxation techniques. The headline, 'Natural birth classes questioned' stands to fuel an already troubling trend that has more women skipping childbirth classes altogether.

Before we get swayed by headlines, let's take a look at the study itself. This randomized controlled trial was conducted in Sweden with roughly 1,000 couples who attended four 2-hour sessions of childbirth education classes in the third trimester of pregnancy. It compared two different types of classes. The 'standard' class gave equal time to childbirth topics as well as early parenthood and newborn care skills. The 'natural birth' class did not cover early parenthood or newborn care, spending that time on relaxation breathing exercises instead. Seventy percent of the women actually used the breathing exercises in labor. The women who took the natural birth class were just as likely to have an epidural (52% in both groups) or give birth by cesarean surgery (20% versus 21%) compared with the women who took the standard classes. Likewise, there were no differences in the memory of labor pain at three months, whether the women reported positive birth experiences, and whether the women or men rated their parenthood experience positively.

There is plenty that this study does not tell us:

• The study tells us nothing about the value or effectiveness of childbirth classes themselves. The study did not include a group that had no childbirth education.
• The study tells us nothing about the use of other interventions, such as induction of labor, continuous electronic fetal monitoring, pitocin augmentation, or episiotomy. It is not surprising that the study does not report on these outcomes, because information about the indications for and side effects of interventions were not included in either type of childbirth class.
• The study does not tell us at what point in labor women got epidurals. Some adverse effects of epidurals, including fevers (which can lead to antibiotic use and separation of the mother and baby after birth) and possibly cesarean surgery, are more likely when epidurals are given early in labor. If breathing and relaxation exercises enable a woman to delay getting an epidural, they might offer some health benefit after all.
• The study does not tell us what other pain relief methods were available to laboring women. It is possible that breathing exercises are more effective when used in combination with other methods, such as immersion in water, continuous doula support, or position changes.

Despite these limitations, the study provides important evidence that breathing techniques alone may not be enough to change women's experience of childbirth, or their exposure to potentially harmful interventions. This trial, which is 'all about the breathing,' reminds us that childbirth education shouldn't be. Lamaze has known this for years, moving away from teaching a particular method or technique and toward educating women about how to achieve safe and healthy birth outcomes. The Six Lamaze Healthy Birth Practices form the foundation for optimal safety and wellbeing. If women are deprived of these basic elements of care &- or don't know about them - the labor experience becomes unnecessarily complex, not to mention more painful. Today's Lamaze can simplify the process by teaching women how their bodies work, how to achieve greater comfort and control, and how to keep the process as safe and healthy as possible.

Citation: Bergstrom, M., Kieler, H., & Waldenstrom, U. (2009). Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG An International Journal of Obstetrics and Gynaecology, doi 10.1111/j.1471-0528.2009.02144.x.

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