Working with Women and Families Towards a Midwifery Model of Childbirth Education, by Julie Brill, CCCE, CLD

I started my formal education as a birth professional twenty-two years ago this month, when I began a yearlong study course with the Massachusetts Midwifery Alliance. It was a great foundation for what would develop into my career as a childbirth educator and mentor of other childbirth educators. Since then my work has attempted to answer the question: What would the midwifery model applied to childbirth education look like?

A primary tenet, I believe, is that our students, our pregnant families, are more important than we are. A class without a teacher can still function as a worthwhile support group, but a teacher without a class is, well you get the idea. Students are busier than ever, and our role as educators is to help them maximize their time in class. I look to my students to set the agenda; it’s one of the first activities they do in class. Some are there to gain information and skills, and to clarify their values, others are more interested in peer support or working together as a family. I check back with them periodically to make sure we are still on track as we collaborate to create their childbirth education experience.

The shape of learning is the spiral not the straight line. Through a student guided agenda, answering questions and a variety of activities intended to appeal to different learning styles, we double back again and again over core information. Families have a chance to have important information and skills reiterated and reinforced.

I want my students to see me as a guide, not an expert. I want to facilitate their transition into parenthood, enhance their abilities to make decisions for themselves and their babies. In class we sit in a circle. If I come in to rows of chairs, I rearrange. It’s a simple act but it changes the dynamic of the class from monologue to dialogue.

A midwife’s job is to build confidence in her client’s ability to birth. How do we enhance that goal as childbirth educators? I look for opportunities to compliment my students on what great parents they already are, when they tell me about healthy decisions they are making or work together well as a team. When I started teaching, filling my students with all the knowledge they needed seemed like such an awesome job that my classes often ran late as I worked to stuff in one more fact or skill. Now I believe that undermines the work I want to be doing building confidence. I strive to end each class a few minutes early so they can digest what we’ve done, ask a question if they want, chat with each other, or simply leave with the feeling that our topics have been well covered.

I also consider not just our intentional curriculum, but the common unintentional one where cbe students learn fear from each other. It’s a huge compliment when a student says she was concerned about becoming more scared in class, but instead now feels calmer and more prepared. I want pregnant women to remember they already know how to labor and birth, and that many of the skills they use to comfort themselves in times of stress will be great tools during labor as well.

The midwifery model emphasizes that pregnancy, labor, birth, and postpartum are times of wellness. I strive to reinforce this with the language choices I make. I say mother instead of patient, birth instead of deliver, intervention instead of hospital procedure. I emphasize the tenets of midwifery care: excellent nutrition and self care (as Anne Frye says, prenatal care is what she does between visits), position change, hydration, nutrition, privacy, and comfort in labor, prepared labor support, etc. I take my students through an entire vision of normal labor and birth before talking about interventions. And my list of interventions  go well beyond pitocin, cesarean birth, and vacuum, to include internal exams, monitoring, pain meds, even changing into a hospital gown is a choice and an intervention.

I try to use language in class that we can all understand. My goal is to make the process of birth seem less medical, less scary, and less complicated. I remember taking a folk class once where the teacher said encouragingly, “It’s called folk dance because all the folk can do it.” All the folk can birth as well, and to me that’s what the midwifery model of childbirth education is all about.

Julie Brill, CCCE, CLD is honored to have taught childbirth education to thousands of families and to have mentored hundreds of childbirth educators. Her next childbirth educator training will be in Westford, MA November 15-17, 2013. More information and registration is at