"First time parents are starting from scratch and that's why they go to antenatal classes. The onus is on antenatal teachers to explain "the concept of choice".
I actually think the fault mainly lies with GP's and midwives, who are the 'gatekeepers' when it comes to maternity services. By the time we see them in their third trimester for what may be perhaps a 12 hour course (of which in my case 6 hours are usually spent on postnatal issues, leaving just 6 hours - minus 2 hours for breaks and chit chat - to cover pain relief, onset of labour, the physiology of labour, induction, c-section and assisted delivery, birth skills, birth support) honestly there's not a huge amount of time for complex and developed discussion around the subject of individual needs and preferences. Not to say I don't try to give some space to this. They've also already made a lot of choices regarding care provider at that point, which understandably they may not want to change.
The journey should have started with the GP at the first visit. That's the point where parents should be asked their thoughts on how they want to be cared for, and what their priorities might be for birth. Even deciding which hospital to go to - that's the GP's job to explain and discuss the issues surrounding setting for birth. That's the point for parents to be signposted to further information and given some time to think it over. But it's not always happening.
"Choice also means understanding the possible consequences of certain interventions. In my experience the agenda of lowering fear and not scaring people from the NCT is so strong that quite a lot of information is not passed onto parents (I have kept my NCT teacher's notes and nowhere can I find the words "anal incontinence" and prolapse is described as "something that could happen later on in life").
No - possibly not a lot of in depth discussion about the following either: birth defects, stillbirth, severe postnatal depression, relationship breakdown, hysterectomy, severe PPH, shoulder dystocia, needing a general anaesthetic for labour, DVTs....... I could fill my entire 12 hour course delivering information to a bunch of scared parents which would totally destroy their peace of mind and ruin the end of their pregnancy. I'm not saying that these things shouldn't be acknowledged and touched on, but in the end the teacher has to deliver a course which is a pretty general exploration of birth and early parenthood - not 'Introduction to obstetric disasters and neonatal emergencies"..
I think the bottom line with antenatal education is to ask the question: what are these classes for? Primarily mothers come to find a peer group, and they (usually, not always) get that in spades with NCT. Of course they need skills and information to make the birth (however it happens) and their first few months with a baby a more manageable experience. But there are limits to what these classes can and should cover.
It's also the case that even if you signpost people clearly to further information and support, the majority won't follow it up. While parents do absolutely colossal amounts of research into what cot or buggy they'll buy, they seem very reluctant to follow up recommendations for further information about birth choices. Doesn't excuse the teacher/midwife from not providing this information for parents though, or making themselves available for further discussion if necessary.
Anyway was going to mention, some hospitals are now running a specialist clinic for women whose preference for how their birth is managed falls outside of the normal NHS protocols. One that I'm aware of is run by a consultant midwife who will see parents whose choices for birth are 'unconventional'. The purpose of this clinic is to give time for indepth discussion of the issues, and to try to find a way forward to meeting the needs of these parents. Really hope more hospitals decide to make this sort of provision for parents - it's a really good thing.