I want to share some information with you about people who have high-risk pregnancies. This topic has been on my mind because my research team found that people experiencing gestational diabetes or gestational hypertension did not experience the same outcomes after attending childbirth education.

Evidence is clear that people who attend childbirth education courses are more likely to breastfeed. However, our investigation found people experiencing gestational diabetes were no more likely to breastfeed if they attended childbirth education. We found a similar pattern for attending the postpartum visit; people who participated in childbirth education were more likely to attend a postpartum visit except people with gestational diabetes. Childbirth education did not even increase the likelihood of a person with gestational diabetes receiving a postpartum diabetes test. Though people who attend childbirth education are more likely to use safe infant sleep practices, this isn’t true for people experiencing gestational diabetes or gestational hypertension. 

People without childbirth complications who attended childbirth education were less likely to have a cesarean birth than people who didn’t attend. But this wasn’t true for people who had gestational hypertension. Concerningly, people who had gestational diabetes were more likely to have a cesarean birth if they attended childbirth education. You can read the full article in the Spring 2023 issue of The Journal of Perinatal Education.

My reason for sharing this information in the Lamaze blog is to start a conversation about these interesting findings and what they mean about opportunities for expanding the types of childbirth education we provide. During the work of interpreting the results, my team identified three characteristics of people experiencing a high-risk pregnancy that suggest a curriculum specifically for high-risk pregnancies could be valuable.

Characteristic 1: People with high-risk conditions in pregnancy experience increased surveillance which means more visits with more types of providers. This may mean they are exposed to increased health messaging on some topics. If this is true, childbirth educators may be able to shift time from topics with existing messaging to topics of special interest to people at high risk.

Characteristic 2: People with high-risk conditions in pregnancy are making different decisions and may need additional information to make decisions. As an example, the standard childbirth education course may not highlight the importance of postpartum follow-up beyond the standard six- to eight-week postpartum checkup. Childbirth educators working with people at high-risk can highlight the value of more frequent check-ins to watch the postpartum blood pressure and the need for a postpartum diabetes test. 

Characteristic 3: People with high-risk conditions in pregnancy are anxious, often feel confused and frustrated, and perceive contradictory information about their condition and treatment options. This may mean that childbirth educators working with people at high-risk should cover content at a slower pace than the standard classes. This would allow more time for the participants to ask questions, identify where they are confused and verbalize the contradictory advice they have received.

What is your experience? Are there common questions you hear from people at high-risk for complications? Do you offer a class specifically for people experiencing complications? Share your experiences by getting published on the Lamaze blog. Contact Content Manager Morgan Manghera at mmanghera@lamaze.org for more information.

In my next post, I’ll share the results of a literature search examining the ways childbirth education has been provided to people at high-risk.

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