Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Preparation for labor and childbirth

Judith A Lothian, RN, PhD, LCCE
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


A woman's experience of birth is vitally important, and her birth memories endure [1,2]. Four factors are particularly important in determining a woman's childbirth experience: personal expectations, the amount of support she receives, the quality of the caregiver-patient relationship, and her involvement in decision-making [3].

This topic will review goals and educational methods that help prepare women for labor and childbirth. Other topics relating to pregnancy are discussed separately (See "Prenatal care: Initial assessment" and "Prenatal care: Second and third trimesters" and "Group prenatal care".)


Women have always prepared for the birth of their babies. Mothers from all cultures traditionally passed their knowledge about labor and birth to their daughters. These cultural and family rituals guided women through pregnancy, labor, birth, and the early days of mothering. Much of women's wisdom about birth was lost when birth moved from home to hospital. Mothers, sisters, and other women knowledgeable about birth no longer attended the woman. Birth became a medical event and cultural and family rituals took a back seat, eventually all but disappearing [4]. The development of structured educational programs in preparation for childbirth came about as the traditional methods of information sharing declined [4,5]. Nurses and physical therapists who knew a great deal about the mechanics and medical management of pregnancy, labor, and birth, began to educate women about childbirth, largely outside of the health care system. Eventually these professionals became formally trained as childbirth educators [5]. Childbirth education focused on two things in those early years: the basic anatomy and physiology of labor and birth and simple strategies (typically relaxation and breathing) to cope with the pain of contractions.

We now know a great deal now about the role of pain in labor [6], the wide and ever increasing number of ways that women find comfort during labor and birth [7], and the importance of continuous emotional and physical support during parturition [8-10]. In addition, some traditional birth practices, such as movement during labor, physiologic pushing [11,12], and the upright position for second stage have been shown to be effective practices in controlled studies [13,14]. Women now prepare for labor and birth with much more knowledge than women did forty years ago.


The major goals of childbirth education are to provide women with the ability to be [15,16]:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 01, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Simkin P. The experience of maternity in a woman's life. J Obstet Gynecol Neonatal Nurs 1996; 25:247.
  2. Simkin P. Just another day in a woman's life? Part II: Nature and consistency of women's long-term memories of their first birth experiences. Birth 1992; 19:64.
  3. Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186:S160.
  4. Ondek M. Historical development. In: Childbirth education: Practice, research, and theory, Nichol F, Humenick S (Eds) (Eds), WB Saunders, Philadelphia 2000.
  5. Zwelling E. Childbirth education in the 1990s and beyond. J Obstet Gynecol Neonatal Nurs 1996; 25:425.
  6. Lothian JA. Really teaching lamaze: the power of pain. J Perinat Educ 1999; 8:viii.
  7. Simkin P. Reducing pain and enhancing progress in labor: a guide to nonpharmacologic methods for maternity caregivers. Birth 1995; 22:161.
  8. Kennell J, Klaus M, McGrath S, et al. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991; 265:2197.
  9. Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol 1999; 180:1054.
  10. Bohren MA, Hofmeyr GJ, Sakala C, et al. Continuous support for women during childbirth. Cochrane Database Syst Rev 2017; 7:CD003766.
  11. Bloom SL, Casey BM, Schaffer JI, et al. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol 2006; 194:10.
  12. Lothian JA. Making the case for a physiologic approach to childbirth. J Perinat Educ 2012; 21:186.
  13. Roberts JE, Mendez-Bauer C, Wodell DA. The effects of maternal position on uterine contractility and efficiency. Birth 1983; 10:243.
  14. Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017; 5:CD002006.
  15. Lothian J. Birth plans: the good, the bad, and the future. J Obstet Gynecol Neonatal Nurs 2006; 35:295.
  16. Lothian J, DeVries C. The Official Lamaze Guide: giving birth with confidence, Meadowbrook Press, Minneapolis 2010.
  17. Lowe NK. The nature of labor pain. Am J Obstet Gynecol 2002; 186:S16.
  18. Buckley S. Hormonal physiology of childbearing: Evidence and implications for mothers, babies, and maternity care. 2014. Washington, DC: Childbirth Connection. http://www.childbirthconnection.org/ (Accessed on October 05, 2015).
  19. Special issue: Safe, healthy birth practices. J Perinat Educ 2014; 23.
  20. Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs 2008; 37:94.
  21. Bonovich L. Recognizing the onset of labor. J Obstet Gynecol Neonatal Nurs 1990; 19:141.
  22. Maimburg RD, Vaeth M, Dürr J, et al. Randomised trial of structured antenatal training sessions to improve the birth process. BJOG 2010; 117:921.
  23. Simpson KR, Newman G, Chirino OR. Patient education to reduce elective labor inductions. MCN Am J Matern Child Nurs 2010; 35:188.
  24. Kistin N, Benton D, Rao S, Sullivan M. Breast-feeding rates among black urban low-income women: effect of prenatal education. Pediatrics 1990; 86:741.
  25. Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev 2007; :CD002869.
  26. Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG 2009; 116:1167.
  27. Hodnett ED, Downe S, Walsh D, Weston J. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev 2010; :CD000012.
  28. Savage JS. Birth stories: a way of knowing in childbirth education. J Perinat Educ 2001; 10:3.
  29. Everyday Miracles. Injoy Videos, Boulder, CO 2000. http://www.lamaze.org/p/cm/ld/fid=49 (Accessed on October 05, 2015).
  30. Gaskin IM. Ina May's Guide to Childbirth, Bantam Books, New York 2003.
  31. Boston Women's Health Collective and Judy Norsegian, 2008.
  32. Simkin P. The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Labor Companions, 4th, Harvard Common Press, Boston 2013.
  33. Simkin P, Ancheta R. The labor progress handbook, 3rd, Wiley-Blackwell, Malden, MA 2011.
  34. Adams SS, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG 2012; 119:1238.
  35. Dick-Read, G. Natural childbirth. Heinemann, 1933.
  36. Lamaze, F. Painless childbirth. Psychoprophylactic method. Burke, London, 1958.
  37. Lothian JA. Safe, healthy birth: what every pregnant woman needs to know. J Perinat Educ 2009; 18:48.
  38. Lothian JA. Lamaze breathing: what every pregnant woman needs to know. J Perinat Educ 2011; 20:118.
  39. Balaskas J. Active birth: The new approach to giving birth naturally, Harvard Common Press, 1992.
  40. Mongan, M. Hypnobirthing: The breakthrough natural approach to safer, easier, more comfortable birthing. Health Communications Inc 2005.
  41. Lothian J. Why become certified? J Perinat Educ 1996; 5:4.
  42. Lothian, J. How large is too large: optimal childbirth class size. J Perinat Educ 1992; 1:3.
  43. De Vries CA, De Vries RG. Childbirth education in the 21st century: an immodest proposal. J Perinat Educ 2007; 16:38.
  44. Lothian JA. Childbirth education at the crossroads. J Perinat Educ 2008; 17:45.