I teach antenatal classes for the NCT. I often wonder how many of the new parents who take NCT antenatal classes or other courses (and there are plenty of other things we do) know, or think of asking, how we got into doing this, why we do it and what the process of becoming an antenatal teacher is.
My NCT story began when I enrolled on an antenatal course, being pregnant for the first time in 1989. A terrifyingly long time ago. I can’t remember why I ended up having to drive over to Queen’s Park for my course – maybe I left booking too late to catch a course closer to my home in Hackney. Anyway we turned up and there was Ilana Mackover, the most graceful and serene person imaginable. She was and still is an Alexander Technique teacher and trainer as well as a founder member of Doula UK. Strangely I cannot remember very much about our classes. I remember liking the other couples and I remember a lovely sense of excitement and enjoyment. I remember going into labour feeling confident and having some techniques ready to put into practice; I felt “I can do this – I know I can do this.”
My husband, Dan, couldn’t attend many sessions, as he was rather busy in Prague and Berlin at the time reporting on the end of Communism and watching the Berlin Wall come down (some would say he helped bring it down with a well-timed question at a press conference, but that’s another story), but he attended enough to get the idea of how to be an excellent birth companion. I will never forget Ilana simply demonstrating to us how much more sense it made for a woman to be upright while birthing her baby, utilising gravity and allowing her pelvis to move naturally. It was a huge “penny drop” moment and as an antenatal teacher today 26 years later, I still see that penny drop in the minds of my clients.
In labour with my firstborn and close to delivery, I was disappointed when a doctor came into the room and loudly asked “what was going on, why is this going on so long?” and ordered me to be on my back with my legs in the air. I made some weak protest but was over-ruled and had to push like crazy to birth my baby boy. Thanks to that doctor, that particular second stage was the most difficult hour of all my four births, and the sense of disempowerment is not something I will ever forget – and I was determined not to feel it again. With the second baby, I requested a birth mat and birthed her on my hands and knees. She landed on the blue birthing mat right next to the words “DONATED BY HACKNEY NCT”. I remember her being examined by the midwife and hearing her explain to the junior midwife with her: “You notice how much more alert this baby is compared with the one we saw earlier today whose mum had Pethidine…” and feeling intensely proud. By the time pregnancy number 3 happened, the Homerton Hospital had installed what they called then a “home from home birth centre”. It was absolute crap but we didn’t think so at the time. The rooms were not very big and largely taken up by a double bed. There was no ensuite bathroom which was just as well, as I am sure having to walk back and forth to the bathroom helped my third baby arrive swiftly.
For pregnancy number 4 we had moved to West London. One look at the old crumbling Queen Charlotte’s Hospital determined me – this was going to be a home birth. And so it was, despite a grim-faced pep talk from a woman obstetrician about the “risks” (which were, studies have since shown, almost entirely imaginary). I began to want to help other women in their birthing journey and, hopefully, to enable some women to make the transition from lithotomy stirrups to home birth more directly than I had managed.
So as soon as all these babies were at school I trained to be a doula, then a hypnobirthing teacher, then a hypnotherapist. But I was always aware that the gold standard of sharing knowledge and empowering birthing women and parents to be lay with the National Childbirth Trust, the organisation that first gave me the confidence I needed to feel positive and brave about birth. Their university-accredited diploma of antenatal education is like no other. It is more thorough and goes in more depth into questions of birthing autonomy and informed choice than any other, as well as requiring a lot of time consuming absorbing of facts. The course was expensive, I had to be approved by my local branch, and do some volunteering for them to show willing – which felt a bit odd as I’m a lot older than most of them. The first task I had was to write an essay on my own birth experiences – this de-briefing process is crucial, as it gets all “that stuff” out of the way so that the practitioner can focus on the needs of the women she is working with. NCT teachers have the same variety of birth experiences as anyone else, and also the same experience of tearing, postnatal depression, breastfeeding problems. My essay was awful and I had to completely rewrite it. That was a learning curve and a half.
We learned how to read and reference academic and medical articles and, crucially, how to understand research. Best of all there was a monthly face to face tutorial with my lovely tutor Sandra Bush and up to 11 other women. Those monthly tutorials were something I looked forward to immensely. Being given that diploma in a Luton church in 2012 actually meant more to me than getting a degree in classics at Oxford.
So now I teach about 120 pregnant women and their partners per year in Signature antenatal courses and waterbirth workshops (and not forgetting the two-dad couple who came along because they wanted to prepare for the arrival of their twins via surrogate!). Unlike many similar organisations the NCT encourages clients to give frank feedback online which is then sent, anonymously, to the practitioners. The vast majority of those who offer feedback are very happy with our courses. They learn stuff, they make friends, they discover options they didn’t realise they had – and on the whole they end up feeling, as I did, hugely more confident about the journey ahead – even though they also know they are going to go through changes which nobody can fully prepare them for. I know that each class will include a huge range of different needs, from the single mum who has been told she must have a caesarean for medical reasons to the mum with a huge supportive family planning to birth at home in a pool… from the couple who have read every book – to the couple who know nothing. My task is to make sure all these people have access to the information they need to make their OWN informed choices, and not have choices foisted on them by others. I freely admit I probably wasn’t very good when I started and I am still “developing”, so the encouragement and positive feedback from my early groups was amazing.
What actually happens in an NCT antenatal class? Lots, and the mix will be different for each practitioner, as with Signature courses we have to plan our own course and take in the preferences of the individual group. The group also determines its own dynamics to some extent though the practitioner has to watch out to see that everyone feels included.
I show pictures of women with epidurals, in birth pools, on birth stools, in hospitals, in homes, and encourage discussion about how to deal with the disadvantages of all approaches to pain relief. I encourage couples to go out and do their own research, to think hard, for example, about how helpful a houseful of noisy relatives is really going to be to an exhausted post-partum woman, to discuss how to keep their own relationships resilient, to look carefully at how baby’s brains (and tummies) develop. They have a chance to try on slings and examine reusable nappies alongside disposable ones, and to explore aspects of birth and babies they may not have thought about. We walk through the procedures and personnel present for straightforward labour, assisted birth, epidurals, caesareans. We walk through the first hours and days with the new baby. We talk about postnatal depression, about crying, about sleep, creating a safe place to air thoughts and feelings that otherwise might not get aired at all. I am starting with a new group this evening and my schedule for two hours includes: inviting the women and partners to set their agendas, an overview of basic straightforward labour, the hormones and physiology of labour, the different environments a woman might find herself in and how these affect her labour hormones: plus, of course, I want the group to get to know each other a bit, and have a fifteen minute break for tea and biscuits (which I supply, by the way, paid for out of my hourly pay).
NCT practitioners work incredibly hard to meet all these requirements. My breastfeeding counsellor colleagues are particularly admirable – they have a fantastic amount of knowledge right at their fingertips, they often know more about infant feeding than your GP and they give a lot of volunteer time too. It is hard to get it all right all the time. In fact when you look at the rate of satisfaction with our courses, it is downright amazing how much we get right, most of the time.
Yet we are treated as a national punchbag – especially by women journalists, even those who have never attended an NCT course but have a skewed notion of what one is like. We are “natural birth Nazis”…”the Breastapo”…etc etc. This is how one journalist last weekend described us: “comedy middle-class yummy mummies flick their hair and talk about how they’ll be breastfeeding for all eternity”.
What can the NCT do to get across to women like this one what we really do? How can the NCT, especially our new CEO Nick Wilkie, get them to listen?