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Pregnancy & Childbirth Education Policy

posted Jul 27, 2011, 5:44 PM by Lisa Baracker   [ updated Jan 11, 2012, 10:53 AM ]
I present to you one of my MPH writing assignments for Health Policy & Management Class which I completed in the Summer of 2011.

Expanding & Adjusting CPSP: A National Policy Proposal

OVERVIEW: The current health care system in the US has a significant black hole when it comes to the care of pregnant women and their babies; physicians tend to utilize the medical model of wait and see rather than the midwifery model of prevent, educate and inform. This is a serious gap in prenatal coverage, which needs to be bridged, so that pregnant women are not treated as diseased but rather accompanied on a journey. Besides, when is comes to pregnancy what is there to treat? Is pregnancy a disease?  The answer is a resounding no. Pregnancy is a normal event in the life cycle of a woman.[i], [ii], [iii] In order for women and their babies to be safe in pregnancy and labor, egalitarianism needs to invade the practices of all care providers in the US, so that shared decision making with pregnant women is the norm.[iv]  In order to accomplish this, pregnancy & childbirth education needs to be offered to all women regardless of their ability to pay and qualified educators need autonomy and monetary incentives to provide such education.

PROBLEM: Quality childbirth education is usually provided by private childbirth educators at a cost to pregnant women and is unattainable by low-income women. “Traditional ways of passing information about birth from generation to generation: storytelling, woman-to-woman support, and making birth part of everyday life by using analogies that help women make connections with what they already know”[v] have gone by the way side leaving women scared and anxious about their pregnancies and about childbirth.  These women usually end up going to childbirth classes at the hospital where they are giving birth because those classes are free, but which are not comprehensive and whose pedagogy is wrought with information about how to be a patient at the hospital rather than information about healthy pregnancy, labor and birth. Comprehensive childbirth classes that teach physiological normal birth are essential to healthy birth outcomes.  These classes should be 10-13 weeks in length and should cover not only normal birth, but also medical interventions, healthy pregnancy, breastfeeding and the postpartum period. When physicians spend prenatal appointments looking for risk diagnoses rather than educating women about pregnancy and childbirth, pregnancy becomes a risky business rather than a normal part of life.  Through childbirth education, women are empowered to become engaged the decision-making process[vi] with their care providers. Pregnancy is not something to be diagnosed; however, in the US providing care in an egalitarian manner is almost universally not the norm. Pregnant women look to care providers to guide them through their pregnancy, but the reality is that most care providers are not able to be with women during every moment of their pregnancy, labor and birth, so education is a must-have to mitigate further deleterious effects on pregnancy outcomes. Recently attendance in childbirth classes has dropped5, [vii] and this puts women at even further risk for complications during pregnancy and labor. “The problems of contemporary birth, including the standard “intervention-intensive” labor and issues related to litigation and patient choice, should not be an excuse for our failures.”5 We must act now to make comprehensive childbirth education available to all pregnant women.

ALTERNATIVE POLICY: The state of California implemented the Comprehensive Perinatal Services Program (CPSP) in 1987 which aims to “decrease the incidence of low birth weight in infants, improve the outcome of every pregnancy, give every baby a healthy start in life and lower health care costs by preventing catastrophic illness in infants and children.”[viii] Such a program is an excellent model for a national policy to provide reimbursement for childbirth education to qualified childbirth educators. CPSP has notoriously been restrictive; allowing reimbursement only for ICEA, Lamaze and Bradley certified childbirth educators,[ix] if and only if they are practicing under a Medicaid Provider, such as a physician or midwife.  This presents an obstacle because most certified childbirth educators operate autonomously and are not supervised by a Medicaid Provider. “The childbirth educator is also a professional in a core position to play an active role as a change agent in the system through evaluation and dissemination of information.”[x] We need to let the providers be the providers and the educators be the educators. California is one of the only states to have a program such as CPSP and the program provides reimbursement for childbirth education; however, expanding CPSP on a national level is a necessary step to making prevention based prenatal care a reality. 

IMPACT: Self-actualization, health responsibility, exercise, nutrition, and interpersonal support[xi] are just a few of the quality improvements associated with childbirth education.  If childbirth education alone can improve these five areas then why is unbiased childbirth education for low-income pregnant women still not available? Expanding CPSP to all 50 states will make quality childbirth education available to all women.  But before implementing a national CPSP, it needs to be adjusted to allow more autonomy among childbirth educators to increase participation and routes to reimbursement via Medicaid.  National adoption of a revised CPSP will change the way pregnant women approach their pregnancies and childbirth.  Many more pregnant women will have access to quality childbirth preparation, not just in California, but across the US. The evidence is clear; most hospital-based classes are inadequate and provide little preparation to pregnant women in comparison to private childbirth education. The cost of implementing CPSP nationwide with adjustments for educator autonomy is minimal in comparison to the cost savings of improving prenatal prevention through quality pregnancy and childbirth education offerings.  The reduction in intervention alone will be astounding when women have access to quality education during pregnancy. This will lead to healthier outcomes for moms and babies, which is the over-reaching goal of the Coalition for Improving Maternity Services’ Mother Friendly Childbirth Initiative.[xii]

CONCLUSION Healthy pregnancy and childbirth education is essential to improving childbirth outcomes because it normalizes many of the fears and anxieties that women have allowing them to feel less anxious during pregnancy and childbirth.[xiii] This prevention strategy alone is a paradigm shift that will elevate the role of women during pregnancy. It will empower women to make sound informed decisions about the care they receive during pregnancy and childbirth. It will change the landscape of the US maternity system.

[i] Davis, E. Women’s Sexual Passages: Finding Pleasure and Intimacy at Every Stage of Life. 1st Ed. Alameda. Hunter House. 2000.


[ii] Gaskin, Ina May. Spiritual Midwifery. 4th Ed. Summertown. The Book Publishing Co. 1975-2002.


[iii] Gaskin, Ina May. Ina May’s Guide to Childbirth. 1st Ed.US. New York. Bantam. 2003.


[iv] Transforming Maternity Care Vision Team, Carter MC, Corry M, Delbanco S, Foster
TC, Friedland R, Gabel R, Gipson T, Jolivet RR, Main E, Sakala C, Simkin P,
Simpson KR. 2020 vision for a high-quality, high-value maternity care system. Womens Health Issues. 2010 Jan-Feb;20(1 Suppl):S7-17. Comment in J Midwifery Womens Health. 2010 Jul;55(4):392-3.


[v] Judith A. Lothian, PhD, RN, LCCE, FACCE. Selling Normal Birth: Six Ways to Make Birth Easier. J Perinat Educ. 2007 Summer; 16(3): 44–46.


[vi] Simpson KR, Newman G, Chirino OR. Patients' perspectives on the role of prepared childbirth education in decision making regarding elective labor induction. J Perinat Educ. 2010 Summer;19(3):21-32.
[vii] Jolivet RR, Corry MP. Steps toward innovative childbirth education: selected strategies from the blueprint for action. J Perinat Educ. 2010 Summer;19(3):17-20.

[viii] Maternal, Child and Adolescent Health (MCAH) Program. Comprehensive Perinatal Services Program (CPSP) Fact Sheet. Accessed via web on 07/01/2011:


[ix] California Family Health Council, Inc., Comprehensive Perinatal Services Program (CPSP) PROVIDER HANDBOOK. Office of  Perinatal Health, Maternal & Child Health Branch, California Department of Health Services. 1999-2001. Accessed via web on 07/01/2011:


[x] 12. Philipsen NC. Promoting and implementing evidence-based, best practices in childbirth education. J Perinat Educ. 2004 Summer;13(3):51-4.


[xi] Mary L. Koehn, PhD(c), ARNP, LCCE, FACCE. Childbirth Education Outcomes: An Integrative Review of the Literature. J Perinat Educ. 2002 Summer; 11(3): 10–19.


[xii] Coalition for Improving Maternity Services. 1500 Sunday Drive, Suite 102. Raleigh, NC 27607. Mother Friendly Childbirth Initivative: The First Consensus Initiative of the Coalition for Improving Maternity Services. 1996. Accessed via web on 07/07/2011:


[xiii] Nolan ML. Information giving and education in pregnancy: a review of qualitative studies. J Perinat Educ. 2009 Fall;18(4):21-30.