Do antenatal classes need to be regulated?

Looking at improvements to birth and parenting education

Taking an antenatal class is almost a rite of passage for parents-to-be. It’s a place where you should learn not just about childbirth but how to look after your baby in those early, sometimes scary, few weeks. But there have been grumblings for some time that antenatal classes are not providing the education they need to be.

I’ve been writing in the parenting space for seven years and for seven years I’ve heard from parents who have had very different experiences in antenatal education.

Pregnancy and Parenting Education in Aotearoa is an interesting mix of public (delivered through DHBs) and private. In theory, every pregnant person or prospective adoptive parent, support person or aiga/fanau/magafaoa can attend free antenatal classes.

Aotearoa’s largest provider of parenting support and education is Parents Centre, but every DHB provides antenatal classes and many Plunket providers do as well. Privately, many midwives, midwifery groups and birth centres also provide classes.

There is no regulation of classes - just guidelines from the Ministry of Health. Funded classes must stick to the Ministry of Health guidelines provided to them. This might sound like a good thing, but parents and birth educators I’ve spoken to have said the guidelines are outdated and not-fit-for-purpose around infant feeding (in regards to providing information about formula) and safe sleeping (in acknowledging there are ways to safely co-sleep).

A birth educator who asked to be anonymous told me: “If we are delivering funded classes and are following the Ministry guidelines, we are not allowed to teach bottle feeding. We are not allowed to talk about safe bed sharing”.

She says she is concerned about the impact this has on new parents.

“It is absurd to me, that we are bound by these guidelines which inadvertently do so much harm to new parents through the guilt and angst it causes. It goes against our own experiences of parenting and our own practices. Private classes on the other hand do not have these constraints, however the downside is that they cost a lot more than funded courses and therefore make them inaccessible to many families.”

“I am currently trying to decide whether I opt for starting my own, private classes where I can teach to my experience and heart but have to build a business at the same time, or if I teach for a funded organisation to get the exposure and experience but have to silence the realities, knowingly causing harm to the mental health of our new parents.”

Photo by Kelly Sikkema

Midwife Lou Kelly of EMPWR NZ a midwifery team that also provides parenting classes says regulation may not be the answer.

“It's really hard to regulate something like antenatal education, because while there does need to be oversight about what is being taught, and by whom, it's also important that people have access to the spaces and the information that is relevant to them. For example hapū wananga and LGBTQIA+ centred antenatal education programmes will look different to standard antenatal education, and for good reason,” Lou says.

However the lack of regulation about who is qualified to teach antenatal education concerns some in the industry.

“Some big organisations offer a six week certificate to be allowed to teach with their organisation, which is nowhere near enough time to understand how to hold space for new and expecting parents, navigate complex questions, and also have enough knowledge to provide evidence based information,” Lou says.

Usually, birth educators come from two camps - midwives and diploma graduates. Within these groups there’s also variation. For example, midwives have a four year degree behind them and huge amounts of experience with pregnancy, birth, and postpartum care, but usually have no taught facilitation skills. Midwives are also shaped by their clinical experience. A midwife who has worked for three years in a high risk tertiary unit is going to have very different clinical experiences than a midwife who has only worked in primary care for ten years - there's no rules about having to have worked across the scope of primary birth, secondary birth, and complex care in order to teach antenatal education.

Ara, a vocational training institute in Canterbury, teaches a Transition to Parenting diploma. These graduates have no clinical experience and are often teaching from a more idealistic point of view of how things should be, and are potentially influenced by their own birth experiences. But they also have far more regulated information, and far more education on facilitation and adult learning.

“I don't know if either of these qualifications is better, but they are very different,” Lou says.

Birth educators undoubtedly have different views around what they will and won’t and can and cannot teach. Topics that are crucial to teach, like how to feed your baby, can be fraught.

Parents have told me how they were not allowed to even ask about “the F word” in classes, setting them up to feel like they were failures if they couldn’t breastfeed or chose not to.

“Formula is the one part of antenatal education that is very strictly regulated. I know that they teach people in the transition to parenting diploma that so much as mentioning the existence of formula within a group setting, will increase the chances of parents using formula,” Lou says.

There are very strict guidelines that the Ministry of Health has adopted from the International Code of Marketing of Breast-Milk Substitutes that restrict formula being advertised. Given Nestle's horrific behaviour in low-income countries, this code exists for a very good reason.

However, these guidelines are arguably hurting parents.

Lou agrees. “What I see time and time again with people postnatally is a deep sense of grief, guilt, failure, and also scrambling for reliable information if they do find themselves needing to use formula for their baby. I think New Zealand has an issue that is amplified in antenatal education by refusing to even mention formula, or bottle feeding: we have a very intense promotion of breastfeeding, and a strong breastfeeding culture, we have really high breastfeeding rates, but that culture and support doesn't exist for those who have trouble breastfeeding postpartum.”

When a parent struggles with breastfeeding, they’re often left on their own.

If we genuinely care about all babies having access to breastmilk for the first six months of life, why are there no government funded human milk banks? Why aren't lactation consultants universally funded for every parent that needs them at any stage in the first six months of life?

Breastfeeding support is a much bigger issue than just antenatal education. But given these classes are the first introduction to parenting for many, it’s an important place to start addressing the stigma around formula use.

New Zealand also seems to be stuck in placing breastfeeding above all other measures of health - yes we have very high breastfeeding rates but why do we also have high maternal suicide rates? High respiratory illness rates for infants and children under 5? Sometimes it feels like health policy makers think breastfeeding will absolve us of needing to provide safe warm housing and comprehensive mental health support. 

Safe co-sleeping is another place where shame is heaped on parents by giving culturally inappropriate guidance and advice that is not rooted in the reality of parenting.

Almost every parent I know was told there is no safe way to co-sleep, a myth that is continually trotted out aggressively at new parents at coffee groups, on social media and by well-meaning folks who simply don’t understand infant sleep. The cycle of policing parents from before their child is even born could be traced to antenatal classes.

“Teaching about safe co-sleeping should be part of antenatal education,” Lou says. “because we know that every single parent will fall asleep in the same bed as their child at some point in the first six months of life - they need to know how to do that safely.”

For their part, The Ministry of Health, through a spokesperson, says they have “no reason to believe that safe sleeping and infant feeding are not adequately covered in publicly funded antenatal classes.”

“The Ministry requires parents to receive ‘safe sleep messaging’ but it isn’t a requirement for parents to be informed that co-sleeping can be safe”.

It’s unlikely anyone goes into birth education wanting to do anything but to help parents. Parents can and do report feeling ashamed and at sea after their antenatal classes. These two statements can be true at the same time.

Regulation may not be the answer, but it may be time to look at the antenatal education landscape and considering where improvements can be made.

The lives of our mothers and babies depend on us getting this right.