Does Lamaze “Work”?

Abstract

In answer to a reader's question, this column affirms that Lamaze preparation for birth is important and valuable.

Question: As a childbirth educator, the refrains I hear more and more frequently are “I learned a lot in my classes, but Lamaze didn't work for me” or “Knowing what to expect was valuable, but the epidural was what I needed to get through labor.” What do I say to women to convince them that Lamaze preparation for birth is important and valuable, and that it “works”?

Answer:In order for something to work, it must perform its required or expected function; it must be effective. What exactly is Lamaze intended to do? What should happen as a result of Lamaze preparation for birth?

Historically, Lamaze was defined as a method of childbirth—an alternative to the use of drugs that produce unconsciousness and, in former years, were a fairly routine part of “modern” childbirth. Lamaze classes helped women understand the basic anatomy and physiology of birth, demystified the medical aura around birth, and taught some very specific skills (physical relaxation and controlled breathing) that could be used as an alternative to pain medications.

Over the last 40 years, our knowledge of normal, natural birth has gone well beyond basic anatomy and physiology. A generation of women who experienced births in hospitals and at home have shared their wisdom with us. At the same time, there is a growing body of research about birth and the ways in which the process of birth is facilitated or sabotaged. The basic knowledge about birth, formerly handed down from one generation of women to the next, has been reclaimed and is now part of the Lamaze curriculum.

Lamaze preparation for childbirth looks different from its appearance 40 years ago because, today, we know much more about normal, natural birth. And, in a very important way, Lamaze preparation looks different because giving birth confidently and naturally today is more difficult than it was 40 years ago. Routine interventions such as sonograms, continuous electronic fetal monitoring, and intravenous procedures give women a subtle but powerful message: Where birth is concerned, nature cannot be relied upon. Women give birth in settings that restrict the freedom to respond appropriately to contractions and provide minimal labor support. Forty years ago, Lamaze worked if women could give birth confidently with little or no medication. However, for Lamaze to work effectively in today's world, it means much more than avoiding medication.

The goal of today's Lamaze is for women to understand both intellectually and intuitively that they have an inherent ability to give birth, that nature has designed birth simply and elegantly, that responding to the pain of labor contractions helps labor along, and, when you get right down to it, that women already know how to give birth. Good classes help women develop the deep confidence they will need to give birth—working very hard, feeling pain but not suffering, and being encouraged and supported every step of the way. When Lamaze works, each woman who attended class waits for labor to begin, secure in the knowledge that her body will know just what to do. She moves through labor listening to her body, guided by what she is feeling, doing just what she needs to do to help labor along.

Lamaze that works has nothing to do with feeling pain, taking or avoiding medication, or developing complications that necessitate medical interventions. It is about trusting one's inner wisdom, having the freedom to work with one's body as labor progresses, and being supported by health care providers, family, and friends who wait patiently for nature to do its incredible work.

Good Lamaze classes tell the simple story of normal, natural birth. They help women develop simple skills that can be used in labor. They also teach women to understand how interventions—even basic interventions such as restrictions on eating, drinking, and walking—influence the normal, natural process of labor and birth. Lamaze is not just a set of techniques that help reduce pain perception. Lamaze is a set of beliefs about birth. Lamaze classes take those beliefs and help women trust birth and develop confidence in their own inherent ability to give birth. Lamaze is learning that “birth works.”

Lamaze that works … is about trusting one's inner wisdom, having the freedom to work with one's body as labor progresses, and being supported by health care providers, family, and friends …

Millions of years of experience in giving birth and at least 50 years of empirical evidence suggest that interfering with the normal, natural process of birth increases complications. Enkin's book (1995)A Guide to Effective Care in Pregnancy and Childbirth presents the results of 20 years of controlled trials in perinatal medicine. It also provides a meta-analyis of these trials and other research published in the field. Enkin's work provides powerful support for the fact that much of what we consider routine obstetric care actually increases the risks to mother and infant. His work also supports the effectiveness of letting nature do its work. This book is an essential reference for all childbirth educators.

Lamaze is the path that should help women find their way to the knowledge that birth works. The knowledge and skills learned in Lamaze classes should give women confidence in their own ability to give birth. However, more elements are needed if birth is to work the way nature intends it to work. Women need the freedom to feel and respond to contractions. They need to be free to move, to change positions, to walk. They need to befree to eat and drink. Women also need to be encouraged, comforted, and supported emotionally and physically by knowledgeable, trustworthy birth attendants— professionals, family, and friends. Lamaze classes are the forum in which to plan for the freedom and support that will help birth work. When Lamaze doesn't work, it usually means something is missing from the equation—confidence, freedom, or support. The birth setting and the health care provider play major roles in this scenario. Confident, Lamaze-prepared women are routinely being deprived of the freedom and support they need to permit birth to work.

Lamaze is the path that should help women find their way to the knowledge that birth works.

Lamaze will achieve its goals when birth is allowed to work in the way that nature intended. And when birth is allowed to work, the question “Does Lamaze work?” will not have to be asked or answered. In the meantime, let's help women reframe how they think about Lamaze. When they leave your class, make sure they know that Lamaze is not a method of childbirth, but a path through the maze of modern obstetrics that will lead to confidence and trust and inner wisdom.